Fw: Clinical Information from Epocrates Online (Premium Version)

October 18, 2007

for art

----- Original Message ----- From: Nancie Barnett

deifspirit@...

Sent: Wednesday, October 17, 2007 6:48 PM

Subject: Clinical Information from Epocrates Online (Premium Version)

The clinical content below is part of the Epocrates® Online database.For a free subscription to Epocrates Online, visit us at http://www.epocrates.com/products/online/index.html.

Message From Senderfor art

Drug

Sutentsunitinib

Adult Dosing

chemotherapy[uses, dosing may vary]Info: for all uses, refer to institution protocols and pkg insert prior to prescribinggastrointestinal stromal tumor, refractory[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal cell CA, advanced[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal dosing[not defined]hepatic dosing[not defined]Peds Dosing

This information is currently unavailable or not applicable for this drug.Contraindications/Cautionshypersens. to drug/class/compon.see Drug Interactionspregnancy not recommendedbreastfeeding not recommendedCHFcaution if thromboembolic event w/in 1ycaution if ischemic cardiac event w/in 1ycaution if HTNcaution if recent surgery/traumacaution if infectionDrug InteractionsContraindicated[atazanavir] contraindicated: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Avoid/Use Alternative[amprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [aprepitant] use alternative: combo may incr. or decr. sunitinib levels (hepatic metab. altered) [barbiturates] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bexarotene] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bosentan] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [carbamazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [clarithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [conivaptan] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [darunavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [delavirdine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dexamethasone] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz/emtricitabine/tenofovir] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo w/ efavirenz may decr. sunitinib levels, efficacy (hepatic metab. induced) [fluvoxamine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fosamprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [grapefruit] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [griseofulvins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [imatinib] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [indinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [itraconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [ketoconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [lopinavir/ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nefazodone] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nelfinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nevirapine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [oxcarbazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [phenytoins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [posaconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [rifabutin] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifampins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifapentine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [saquinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [st. 's wort] avoid concurrent use: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [telithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [tipranavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [voriconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Monitor/Modify Tx[growth hormone] caution advised: combo may decr. sunitinib levels, efficacy (hepatic metab. possibly induced) [lapatinib] caution advised, consider lower sunitinib doses: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Caution Advised[amiodarone] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dasatinib] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fluconazole] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [octreotide] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. possibly inhibited) [ranolazine] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Adverse ReactionsSerious ReactionsCHFMIHTN, severethromboembolismhemorrhage, majorneutropeniathrombocytopeniaGI perforation (rare)pancreatitis (rare)hypothyroidismadrenal insufficiencyadrenal toxicity (animal studies)seizures (rare)Common Reactionsneutropeniaelevated ALT, AST, bilirubinlymphopeniathrombocytopeniadiarrheaabdominal painanorexianausea/vomitingskin discolorationmucositis/stomatitiselevated amylase/lipaseelevated alk phosastheniataste changesconstipationbleedingfeverHTNrashhand-foot syndromemyalgia/arthralgiahypokalemiaheadacheback paindecreased LVEFdyspneahypernatremiaanemiaelevated CrcoughSafety MonitoringPregnancy: DLactation: Possibly UnsafeMonitoring Parameters: CBC, Plt, serum chemistries (incl. PO4) prior to each cycle; LVEF at baseline, then if cardiac risk factors cont. periodically; BPPharmacologyMetabolism: liver; CYP450: 3A4 substrate; Info: active metaboliteExcretion: feces 61%, urine 16%; Half-life: 40-60h (parent), 80-110h (metabolite)Class: Other Oncologics Mechanism Of Action: inhibits phosphorylation of multiple tyrosine kinases, resulting in anti-cancer and anti-angiogenesis effects Manufacturer/PricingManufacturer: Pfizer Inc.DEA/FDA: Rx

Patient Education

Generic Name:

sunitinib

Pronounced:

soo NIT in ib

What is the most important information I should know about sunitinib?

Do not use this medication if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.

Before using sunitinib, tell your doctor if you have high blood pressure, a thyroid disorder, a heart rhythm disorder, or if you have ever had a heart attack, congestive heart failure, a stroke, or blood clots.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Stop using sunitinib and call your doctor at once if you have chest pain, shortness or breath, sudden numbness or weakness, sudden headache or vision problems, or any unusual bruising or bleeding.

What is sunitinib?

Sunitinib is a cancer medicine that helps the body slow down the growth and reproduction of certain cells, including tumor cells.

Sunitinib is used to treat certain types of advanced or progressive tumors of the digestive system or the kidneys.

Sunitinib may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before using sunitinib?

Before using sunitinib, tell your doctor if you have:

high blood pressure;

a thyroid disorder;

a heart rhythm disorder;

a personal or family history of "Long QT syndrome";

a history of heart attack or congestive heart failure; or

a history of stroke, blood clots, coronary artery disease, bypass graft surgery, or transient ischemic attack (TIA).

If you have any of these conditions, you may not be able to use sunitinib or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category D: This medication can cause harm to an unborn baby. Do not use sunitinib if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.

It is not known if sunitinib passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take sunitinib?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Sunitinib is usually taken once every day for 4 weeks, followed by 2 weeks off the drug. Your doctor will determine how many complete treatment cycles you need based on your condition.

Sunitinib may be taken with or without food.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Store sunitinib at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a sunitinib overdose may include muscle weakness, shaking or chills, and stomach pain.

What should I avoid while taking sunitinib?

Avoid taking an herbal supplement containing St. 's wort at the same time you are taking sunitinib.

What are the possible side effects of sunitinib?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using sunitinib and call your doctor at once if you have any of these serious side effects:

chest pain, general ill feeling;

uneven heart rate;

feeling short of breath, even with mild exertion;

swelling of your ankles or feet;

weakness, tired feeling, nausea, loss of appetite, weight loss;

sudden numbness or weakness, especially on one side of the body;

sudden headache, confusion, problems with vision, speech, or balance;

redness, tenderness, sunburn-like peeling of the palms of your hands or the soles of your feet;

bloody, or black, tarry stools;

coughing up blood or vomit that looks like coffee grounds;

easy bruising or bleeding, unusual weakness; or

white patches or sores inside your mouth or on your lips.

Keep using sunitinib and talk with your doctor if you have any of these less serious side effects:

unusual or unpleasant taste in the mouth;

nausea, vomiting, stomach pain or upset;

diarrhea or constipation;

skin rash, hair loss, changes in skin or hair color; or

headache, joint or muscle pain.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect sunitinib?

Before taking sunitinib, tell your doctor if you are using any of the following drugs:

ketoconazole (Nizoral), itraconazole (Sporanox), voriconazole (VFend);

dexamethasone (Decadron, Dexacort);

nefazodone (Serzone);

seizure medicines such as carbamazepine (Carbatrol, Tegretol), phenytoin (Dilantin), or phenobarbital (Luminal, Solfoton);

rifampin (Rifadin, Rimactane), rifabutin (Mycobutin), rifapentin (Priftin);

clarithromycin (Biaxin), telithromycin (Ketek); or

HIV medicines such as atazanavir (Reyataz), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Invirase, Fortovase).

If you are using any of these drugs, you may not be able to take sunitinib, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect sunitinib. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist has information about sunitinib written for health professionals that you may read.

What does my medication look like?

Sunitinib is available with a prescription under the brand name Sutent. Other brand or generic forms may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

Sutent 12.5 mg--orange capsule

Sutent 25 mg--caramel and orange capsule

Sutent 50 mg--caramel capsule

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Pill Pictures

This information is currently unavailable or not applicable for this drug.

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October 18, 2007

Excellent Nancie! I adding this to the links too. Blessings, Joy It's added.

----- Original Message -----

From: Nancie Barnett

NaturalRemedies

Sent: Wednesday, October 17, 2007 9:52 PM

Subject: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

for art

----- Original Message ----- From: Nancie Barnett

deifspirit@...

Sent: Wednesday, October 17, 2007 6:48 PM

Subject: Clinical Information from Epocrates Online (Premium Version)

The clinical content below is part of the Epocrates® Online database.For a free subscription to Epocrates Online, visit us at http://www.epocrates.com/products/online/index.html.

Message From Senderfor art

Drug

Sutentsunitinib

Adult Dosing

chemotherapy[uses, dosing may vary]Info: for all uses, refer to institution protocols and pkg insert prior to prescribinggastrointestinal stromal tumor, refractory[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal cell CA, advanced[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal dosing[not defined]hepatic dosing[not defined]Peds Dosing

This information is currently unavailable or not applicable for this drug.Contraindications/Cautionshypersens. to drug/class/compon.see Drug Interactionspregnancy not recommendedbreastfeeding not recommendedCHFcaution if thromboembolic event w/in 1ycaution if ischemic cardiac event w/in 1ycaution if HTNcaution if recent surgery/traumacaution if infectionDrug InteractionsContraindicated[atazanavir] contraindicated: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Avoid/Use Alternative[amprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [aprepitant] use alternative: combo may incr. or decr. sunitinib levels (hepatic metab. altered) [barbiturates] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bexarotene] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bosentan] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [carbamazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [clarithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [conivaptan] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [darunavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [delavirdine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dexamethasone] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz/emtricitabine/tenofovir] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo w/ efavirenz may decr. sunitinib levels, efficacy (hepatic metab. induced) [fluvoxamine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fosamprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [grapefruit] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [griseofulvins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [imatinib] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [indinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [itraconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [ketoconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [lopinavir/ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nefazodone] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nelfinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nevirapine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [oxcarbazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [phenytoins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [posaconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [rifabutin] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifampins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifapentine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [saquinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [st. 's wort] avoid concurrent use: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [telithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [tipranavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [voriconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Monitor/Modify Tx[growth hormone] caution advised: combo may decr. sunitinib levels, efficacy (hepatic metab. possibly induced) [lapatinib] caution advised, consider lower sunitinib doses: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Caution Advised[amiodarone] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dasatinib] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fluconazole] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [octreotide] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. possibly inhibited) [ranolazine] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Adverse ReactionsSerious ReactionsCHFMIHTN, severethromboembolismhemorrhage, majorneutropeniathrombocytopeniaGI perforation (rare)pancreatitis (rare)hypothyroidismadrenal insufficiencyadrenal toxicity (animal studies)seizures (rare)Common Reactionsneutropeniaelevated ALT, AST, bilirubinlymphopeniathrombocytopeniadiarrheaabdominal painanorexianausea/vomitingskin discolorationmucositis/stomatitiselevated amylase/lipaseelevated alk phosastheniataste changesconstipationbleedingfeverHTNrashhand-foot syndromemyalgia/arthralgiahypokalemiaheadacheback paindecreased LVEFdyspneahypernatremiaanemiaelevated CrcoughSafety MonitoringPregnancy: DLactation: Possibly UnsafeMonitoring Parameters: CBC, Plt, serum chemistries (incl. PO4) prior to each cycle; LVEF at baseline, then if cardiac risk factors cont. periodically; BPPharmacologyMetabolism: liver; CYP450: 3A4 substrate; Info: active metaboliteExcretion: feces 61%, urine 16%; Half-life: 40-60h (parent), 80-110h (metabolite)Class: Other Oncologics Mechanism Of Action: inhibits phosphorylation of multiple tyrosine kinases, resulting in anti-cancer and anti-angiogenesis effects Manufacturer/PricingManufacturer: Pfizer Inc.DEA/FDA: Rx

Patient Education

Generic Name:

sunitinib

Pronounced:

soo NIT in ib

What is the most important information I should know about sunitinib?

Do not use this medication if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.

Before using sunitinib, tell your doctor if you have high blood pressure, a thyroid disorder, a heart rhythm disorder, or if you have ever had a heart attack, congestive heart failure, a stroke, or blood clots.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Stop using sunitinib and call your doctor at once if you have chest pain, shortness or breath, sudden numbness or weakness, sudden headache or vision problems, or any unusual bruising or bleeding.

What is sunitinib?

Sunitinib is a cancer medicine that helps the body slow down the growth and reproduction of certain cells, including tumor cells.

Sunitinib is used to treat certain types of advanced or progressive tumors of the digestive system or the kidneys.

Sunitinib may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before using sunitinib?

Before using sunitinib, tell your doctor if you have:

high blood pressure;

a thyroid disorder;

a heart rhythm disorder;

a personal or family history of "Long QT syndrome";

a history of heart attack or congestive heart failure; or

a history of stroke, blood clots, coronary artery disease, bypass graft surgery, or transient ischemic attack (TIA).

If you have any of these conditions, you may not be able to use sunitinib or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category D: This medication can cause harm to an unborn baby. Do not use sunitinib if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.

It is not known if sunitinib passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take sunitinib?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Sunitinib is usually taken once every day for 4 weeks, followed by 2 weeks off the drug. Your doctor will determine how many complete treatment cycles you need based on your condition.

Sunitinib may be taken with or without food.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Store sunitinib at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a sunitinib overdose may include muscle weakness, shaking or chills, and stomach pain.

What should I avoid while taking sunitinib?

Avoid taking an herbal supplement containing St. 's wort at the same time you are taking sunitinib.

What are the possible side effects of sunitinib?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using sunitinib and call your doctor at once if you have any of these serious side effects:

chest pain, general ill feeling;

uneven heart rate;

feeling short of breath, even with mild exertion;

swelling of your ankles or feet;

weakness, tired feeling, nausea, loss of appetite, weight loss;

sudden numbness or weakness, especially on one side of the body;

sudden headache, confusion, problems with vision, speech, or balance;

redness, tenderness, sunburn-like peeling of the palms of your hands or the soles of your feet;

bloody, or black, tarry stools;

coughing up blood or vomit that looks like coffee grounds;

easy bruising or bleeding, unusual weakness; or

white patches or sores inside your mouth or on your lips.

Keep using sunitinib and talk with your doctor if you have any of these less serious side effects:

unusual or unpleasant taste in the mouth;

nausea, vomiting, stomach pain or upset;

diarrhea or constipation;

skin rash, hair loss, changes in skin or hair color; or

headache, joint or muscle pain.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect sunitinib?

Before taking sunitinib, tell your doctor if you are using any of the following drugs:

ketoconazole (Nizoral), itraconazole (Sporanox), voriconazole (VFend);

dexamethasone (Decadron, Dexacort);

nefazodone (Serzone);

seizure medicines such as carbamazepine (Carbatrol, Tegretol), phenytoin (Dilantin), or phenobarbital (Luminal, Solfoton);

rifampin (Rifadin, Rimactane), rifabutin (Mycobutin), rifapentin (Priftin);

clarithromycin (Biaxin), telithromycin (Ketek); or

HIV medicines such as atazanavir (Reyataz), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Invirase, Fortovase).

If you are using any of these drugs, you may not be able to take sunitinib, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect sunitinib. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist has information about sunitinib written for health professionals that you may read.

What does my medication look like?

Sunitinib is available with a prescription under the brand name Sutent. Other brand or generic forms may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

Sutent 12.5 mg--orange capsule

Sutent 25 mg--caramel and orange capsule

Sutent 50 mg--caramel capsule

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Pill Pictures

This information is currently unavailable or not applicable for this drug.

Substantial effort has been made to ensure that the information provided by Epocrates is accurate and up-to-date, but this information is not intended to cover all possible uses, precautions, or other considerations relating to the therapies covered. Epocrates does not advocate or endorse the use of any drug or other therapy and does not diagnose patients. Healthcare professionals should use their professional judgment in using this information, and this information should not be considered a substitute for the care and professional judgment provided by a licensed healthcare practitioner. This information if provided on an "as is" basis, and Epocrates and its affiliates, agents and licensors assume no responsibility for any aspect of healthcare administered with the aid of this information or any other use of the information.

Receipt of this message does not mean that you have been opted into Epocrates email. If you wish to ensure that you do not receive any further emails of this type from Epocrates, please email unsubscribe@....

No virus found in this incoming message.Checked by AVG Free Edition. Version: 7.5.488 / Virus Database: 269.14.13/1075 - Release Date: 10/17/2007 9:38 AM

October 18, 2007

I have this because I am a nurse practitioner.

nancie

----- Original Message -----

From: Joyce Hudson

Sent: Wednesday, October 17, 2007 7:18 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

Excellent Nancie! I adding this to the links too. Blessings, Joy It's added.

----- Original Message -----

From: Nancie Barnett

NaturalRemedies

Sent: Wednesday, October 17, 2007 9:52 PM

Subject: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

for art

----- Original Message ----- From: Nancie Barnett

deifspiritmsn

Sent: Wednesday, October 17, 2007 6:48 PM

Subject: Clinical Information from Epocrates Online (Premium Version)

The clinical content below is part of the Epocrates® Online database.For a free subscription to Epocrates Online, visit us at http://www.epocrates.com/products/online/index.html.

Message From Senderfor art

Drug

Sutentsunitinib

Adult Dosing

chemotherapy[uses, dosing may vary]Info: for all uses, refer to institution protocols and pkg insert prior to prescribinggastrointestinal stromal tumor, refractory[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal cell CA, advanced[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal dosing[not defined]hepatic dosing[not defined]Peds Dosing

This information is currently unavailable or not applicable for this drug.Contraindications/Cautionshypersens. to drug/class/compon.see Drug Interactionspregnancy not recommendedbreastfeeding not recommendedCHFcaution if thromboembolic event w/in 1ycaution if ischemic cardiac event w/in 1ycaution if HTNcaution if recent surgery/traumacaution if infectionDrug InteractionsContraindicated[atazanavir] contraindicated: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Avoid/Use Alternative[amprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [aprepitant] use alternative: combo may incr. or decr. sunitinib levels (hepatic metab. altered) [barbiturates] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bexarotene] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bosentan] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [carbamazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [clarithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [conivaptan] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [darunavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [delavirdine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dexamethasone] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz/emtricitabine/tenofovir] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo w/ efavirenz may decr. sunitinib levels, efficacy (hepatic metab. induced) [fluvoxamine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fosamprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [grapefruit] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [griseofulvins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [imatinib] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [indinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [itraconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [ketoconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [lopinavir/ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nefazodone] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nelfinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nevirapine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [oxcarbazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [phenytoins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [posaconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [rifabutin] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifampins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifapentine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [saquinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [st. 's wort] avoid concurrent use: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [telithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [tipranavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [voriconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Monitor/Modify Tx[growth hormone] caution advised: combo may decr. sunitinib levels, efficacy (hepatic metab. possibly induced) [lapatinib] caution advised, consider lower sunitinib doses: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Caution Advised[amiodarone] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dasatinib] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fluconazole] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [octreotide] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. possibly inhibited) [ranolazine] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Adverse ReactionsSerious ReactionsCHFMIHTN, severethromboembolismhemorrhage, majorneutropeniathrombocytopeniaGI perforation (rare)pancreatitis (rare)hypothyroidismadrenal insufficiencyadrenal toxicity (animal studies)seizures (rare)Common Reactionsneutropeniaelevated ALT, AST, bilirubinlymphopeniathrombocytopeniadiarrheaabdominal painanorexianausea/vomitingskin discolorationmucositis/stomatitiselevated amylase/lipaseelevated alk phosastheniataste changesconstipationbleedingfeverHTNrashhand-foot syndromemyalgia/arthralgiahypokalemiaheadacheback paindecreased LVEFdyspneahypernatremiaanemiaelevated CrcoughSafety MonitoringPregnancy: DLactation: Possibly UnsafeMonitoring Parameters: CBC, Plt, serum chemistries (incl. PO4) prior to each cycle; LVEF at baseline, then if cardiac risk factors cont. periodically; BPPharmacologyMetabolism: liver; CYP450: 3A4 substrate; Info: active metaboliteExcretion: feces 61%, urine 16%; Half-life: 40-60h (parent), 80-110h (metabolite)Class: Other Oncologics Mechanism Of Action: inhibits phosphorylation of multiple tyrosine kinases, resulting in anti-cancer and anti-angiogenesis effects Manufacturer/PricingManufacturer: Pfizer Inc.DEA/FDA: Rx

Patient Education

Generic Name:

sunitinib

Pronounced:

soo NIT in ib

What is the most important information I should know about sunitinib?

Do not use this medication if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.

Before using sunitinib, tell your doctor if you have high blood pressure, a thyroid disorder, a heart rhythm disorder, or if you have ever had a heart attack, congestive heart failure, a stroke, or blood clots.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Stop using sunitinib and call your doctor at once if you have chest pain, shortness or breath, sudden numbness or weakness, sudden headache or vision problems, or any unusual bruising or bleeding.

What is sunitinib?

Sunitinib is a cancer medicine that helps the body slow down the growth and reproduction of certain cells, including tumor cells.

Sunitinib is used to treat certain types of advanced or progressive tumors of the digestive system or the kidneys.

Sunitinib may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before using sunitinib?

Before using sunitinib, tell your doctor if you have:

high blood pressure;

a thyroid disorder;

a heart rhythm disorder;

a personal or family history of "Long QT syndrome";

a history of heart attack or congestive heart failure; or

a history of stroke, blood clots, coronary artery disease, bypass graft surgery, or transient ischemic attack (TIA).

If you have any of these conditions, you may not be able to use sunitinib or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category D: This medication can cause harm to an unborn baby. Do not use sunitinib if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.

It is not known if sunitinib passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take sunitinib?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Sunitinib is usually taken once every day for 4 weeks, followed by 2 weeks off the drug. Your doctor will determine how many complete treatment cycles you need based on your condition.

Sunitinib may be taken with or without food.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Store sunitinib at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a sunitinib overdose may include muscle weakness, shaking or chills, and stomach pain.

What should I avoid while taking sunitinib?

Avoid taking an herbal supplement containing St. 's wort at the same time you are taking sunitinib.

What are the possible side effects of sunitinib?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using sunitinib and call your doctor at once if you have any of these serious side effects:

chest pain, general ill feeling;

uneven heart rate;

feeling short of breath, even with mild exertion;

swelling of your ankles or feet;

weakness, tired feeling, nausea, loss of appetite, weight loss;

sudden numbness or weakness, especially on one side of the body;

sudden headache, confusion, problems with vision, speech, or balance;

redness, tenderness, sunburn-like peeling of the palms of your hands or the soles of your feet;

bloody, or black, tarry stools;

coughing up blood or vomit that looks like coffee grounds;

easy bruising or bleeding, unusual weakness; or

white patches or sores inside your mouth or on your lips.

Keep using sunitinib and talk with your doctor if you have any of these less serious side effects:

unusual or unpleasant taste in the mouth;

nausea, vomiting, stomach pain or upset;

diarrhea or constipation;

skin rash, hair loss, changes in skin or hair color; or

headache, joint or muscle pain.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect sunitinib?

Before taking sunitinib, tell your doctor if you are using any of the following drugs:

ketoconazole (Nizoral), itraconazole (Sporanox), voriconazole (VFend);

dexamethasone (Decadron, Dexacort);

nefazodone (Serzone);

seizure medicines such as carbamazepine (Carbatrol, Tegretol), phenytoin (Dilantin), or phenobarbital (Luminal, Solfoton);

rifampin (Rifadin, Rimactane), rifabutin (Mycobutin), rifapentin (Priftin);

clarithromycin (Biaxin), telithromycin (Ketek); or

HIV medicines such as atazanavir (Reyataz), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Invirase, Fortovase).

If you are using any of these drugs, you may not be able to take sunitinib, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect sunitinib. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist has information about sunitinib written for health professionals that you may read.

What does my medication look like?

Sunitinib is available with a prescription under the brand name Sutent. Other brand or generic forms may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

Sutent 12.5 mg--orange capsule

Sutent 25 mg--caramel and orange capsule

Sutent 50 mg--caramel capsule

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Pill Pictures

This information is currently unavailable or not applicable for this drug.

Substantial effort has been made to ensure that the information provided by Epocrates is accurate and up-to-date, but this information is not intended to cover all possible uses, precautions, or other considerations relating to the therapies covered. Epocrates does not advocate or endorse the use of any drug or other therapy and does not diagnose patients. Healthcare professionals should use their professional judgment in using this information, and this information should not be considered a substitute for the care and professional judgment provided by a licensed healthcare practitioner. This information if provided on an "as is" basis, and Epocrates and its affiliates, agents and licensors assume no responsibility for any aspect of healthcare administered with the aid of this information or any other use of the information.

Receipt of this message does not mean that you have been opted into Epocrates email. If you wish to ensure that you do not receive any further emails of this type from Epocrates, please email unsubscribeonline (DOT) epocrates.com.

No virus found in this incoming message.Checked by AVG Free Edition. Version: 7.5.488 / Virus Database: 269.14.13/1075 - Release Date: 10/17/2007 9:38 AM

October 18, 2007

Nancie, I am thrilled that you are a nurse practioner! You will have so much to share with us. And please do share! And if you know something that you have seen the opposite of what we post, please feel free to speak up.

I wonder if we have any other medical people here?

Blessings in Love and Light. Joy

----- Original Message -----

From: Nancie Barnett

Sent: Wednesday, October 17, 2007 10:23 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

I have this because I am a nurse practitioner.

nancie

----- Original Message -----

From: Joyce Hudson

Sent: Wednesday, October 17, 2007 7:18 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

Excellent Nancie! I adding this to the links too. Blessings, Joy It's added.

----- Original Message -----

From: Nancie Barnett

NaturalRemedies

Sent: Wednesday, October 17, 2007 9:52 PM

Subject: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

for art

----- Original Message ----- From: Nancie Barnett

deifspiritmsn

Sent: Wednesday, October 17, 2007 6:48 PM

Subject: Clinical Information from Epocrates Online (Premium Version)

The clinical content below is part of the Epocrates® Online database.For a free subscription to Epocrates Online, visit us at http://www.epocrates.com/products/online/index.html.

Message From Senderfor art

Drug

Sutentsunitinib

Adult Dosing

chemotherapy[uses, dosing may vary]Info: for all uses, refer to institution protocols and pkg insert prior to prescribinggastrointestinal stromal tumor, refractory[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal cell CA, advanced[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal dosing[not defined]hepatic dosing[not defined]Peds Dosing

This information is currently unavailable or not applicable for this drug.Contraindications/Cautionshypersens. to drug/class/compon.see Drug Interactionspregnancy not recommendedbreastfeeding not recommendedCHFcaution if thromboembolic event w/in 1ycaution if ischemic cardiac event w/in 1ycaution if HTNcaution if recent surgery/traumacaution if infectionDrug InteractionsContraindicated[atazanavir] contraindicated: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Avoid/Use Alternative[amprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [aprepitant] use alternative: combo may incr. or decr. sunitinib levels (hepatic metab. altered) [barbiturates] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bexarotene] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bosentan] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [carbamazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [clarithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [conivaptan] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [darunavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [delavirdine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dexamethasone] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz/emtricitabine/tenofovir] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo w/ efavirenz may decr. sunitinib levels, efficacy (hepatic metab. induced) [fluvoxamine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fosamprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [grapefruit] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [griseofulvins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [imatinib] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [indinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [itraconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [ketoconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [lopinavir/ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nefazodone] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nelfinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nevirapine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [oxcarbazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [phenytoins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [posaconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [rifabutin] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifampins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifapentine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [saquinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [st. 's wort] avoid concurrent use: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [telithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [tipranavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [voriconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Monitor/Modify Tx[growth hormone] caution advised: combo may decr. sunitinib levels, efficacy (hepatic metab. possibly induced) [lapatinib] caution advised, consider lower sunitinib doses: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Caution Advised[amiodarone] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dasatinib] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fluconazole] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [octreotide] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. possibly inhibited) [ranolazine] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Adverse ReactionsSerious ReactionsCHFMIHTN, severethromboembolismhemorrhage, majorneutropeniathrombocytopeniaGI perforation (rare)pancreatitis (rare)hypothyroidismadrenal insufficiencyadrenal toxicity (animal studies)seizures (rare)Common Reactionsneutropeniaelevated ALT, AST, bilirubinlymphopeniathrombocytopeniadiarrheaabdominal painanorexianausea/vomitingskin discolorationmucositis/stomatitiselevated amylase/lipaseelevated alk phosastheniataste changesconstipationbleedingfeverHTNrashhand-foot syndromemyalgia/arthralgiahypokalemiaheadacheback paindecreased LVEFdyspneahypernatremiaanemiaelevated CrcoughSafety MonitoringPregnancy: DLactation: Possibly UnsafeMonitoring Parameters: CBC, Plt, serum chemistries (incl. PO4) prior to each cycle; LVEF at baseline, then if cardiac risk factors cont. periodically; BPPharmacologyMetabolism: liver; CYP450: 3A4 substrate; Info: active metaboliteExcretion: feces 61%, urine 16%; Half-life: 40-60h (parent), 80-110h (metabolite)Class: Other Oncologics Mechanism Of Action: inhibits phosphorylation of multiple tyrosine kinases, resulting in anti-cancer and anti-angiogenesis effects Manufacturer/PricingManufacturer: Pfizer Inc.DEA/FDA: Rx

Patient Education

Generic Name:

sunitinib

Pronounced:

soo NIT in ib

What is the most important information I should know about sunitinib?

Do not use this medication if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.

Before using sunitinib, tell your doctor if you have high blood pressure, a thyroid disorder, a heart rhythm disorder, or if you have ever had a heart attack, congestive heart failure, a stroke, or blood clots.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Stop using sunitinib and call your doctor at once if you have chest pain, shortness or breath, sudden numbness or weakness, sudden headache or vision problems, or any unusual bruising or bleeding.

What is sunitinib?

Sunitinib is a cancer medicine that helps the body slow down the growth and reproduction of certain cells, including tumor cells.

Sunitinib is used to treat certain types of advanced or progressive tumors of the digestive system or the kidneys.

Sunitinib may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before using sunitinib?

Before using sunitinib, tell your doctor if you have:

high blood pressure;

a thyroid disorder;

a heart rhythm disorder;

a personal or family history of "Long QT syndrome";

a history of heart attack or congestive heart failure; or

a history of stroke, blood clots, coronary artery disease, bypass graft surgery, or transient ischemic attack (TIA).

If you have any of these conditions, you may not be able to use sunitinib or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category D: This medication can cause harm to an unborn baby. Do not use sunitinib if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.

It is not known if sunitinib passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take sunitinib?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Sunitinib is usually taken once every day for 4 weeks, followed by 2 weeks off the drug. Your doctor will determine how many complete treatment cycles you need based on your condition.

Sunitinib may be taken with or without food.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Store sunitinib at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a sunitinib overdose may include muscle weakness, shaking or chills, and stomach pain.

What should I avoid while taking sunitinib?

Avoid taking an herbal supplement containing St. 's wort at the same time you are taking sunitinib.

What are the possible side effects of sunitinib?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using sunitinib and call your doctor at once if you have any of these serious side effects:

chest pain, general ill feeling;

uneven heart rate;

feeling short of breath, even with mild exertion;

swelling of your ankles or feet;

weakness, tired feeling, nausea, loss of appetite, weight loss;

sudden numbness or weakness, especially on one side of the body;

sudden headache, confusion, problems with vision, speech, or balance;

redness, tenderness, sunburn-like peeling of the palms of your hands or the soles of your feet;

bloody, or black, tarry stools;

coughing up blood or vomit that looks like coffee grounds;

easy bruising or bleeding, unusual weakness; or

white patches or sores inside your mouth or on your lips.

Keep using sunitinib and talk with your doctor if you have any of these less serious side effects:

unusual or unpleasant taste in the mouth;

nausea, vomiting, stomach pain or upset;

diarrhea or constipation;

skin rash, hair loss, changes in skin or hair color; or

headache, joint or muscle pain.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect sunitinib?

Before taking sunitinib, tell your doctor if you are using any of the following drugs:

ketoconazole (Nizoral), itraconazole (Sporanox), voriconazole (VFend);

dexamethasone (Decadron, Dexacort);

nefazodone (Serzone);

seizure medicines such as carbamazepine (Carbatrol, Tegretol), phenytoin (Dilantin), or phenobarbital (Luminal, Solfoton);

rifampin (Rifadin, Rimactane), rifabutin (Mycobutin), rifapentin (Priftin);

clarithromycin (Biaxin), telithromycin (Ketek); or

HIV medicines such as atazanavir (Reyataz), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Invirase, Fortovase).

If you are using any of these drugs, you may not be able to take sunitinib, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect sunitinib. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist has information about sunitinib written for health professionals that you may read.

What does my medication look like?

Sunitinib is available with a prescription under the brand name Sutent. Other brand or generic forms may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

Sutent 12.5 mg--orange capsule

Sutent 25 mg--caramel and orange capsule

Sutent 50 mg--caramel capsule

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Pill Pictures

This information is currently unavailable or not applicable for this drug.

Substantial effort has been made to ensure that the information provided by Epocrates is accurate and up-to-date, but this information is not intended to cover all possible uses, precautions, or other considerations relating to the therapies covered. Epocrates does not advocate or endorse the use of any drug or other therapy and does not diagnose patients. Healthcare professionals should use their professional judgment in using this information, and this information should not be considered a substitute for the care and professional judgment provided by a licensed healthcare practitioner. This information if provided on an "as is" basis, and Epocrates and its affiliates, agents and licensors assume no responsibility for any aspect of healthcare administered with the aid of this information or any other use of the information.

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No virus found in this incoming message.Checked by AVG Free Edition. Version: 7.5.488 / Virus Database: 269.14.13/1075 - Release Date: 10/17/2007 9:38 AM

October 18, 2007

I take it 3 weeks off 1 week and mine is 50MG.

I have abdominal painanorexianausea/vomitingskin discolorationtaste changesconstipationRash

back pain

swelling of your ankles or feet;

weakness, tired feeling, nausea, loss of appetite, weight loss;

sudden numbness or weakness, especially on one side of the body;

redness, tenderness, sunburn-like peeling of the palms of your hands or the soles of your feet;

bloody, or black, tarry stools;

white patches or sores inside your mouth or on your lips.

unusual or unpleasant taste in the mouth;

nausea,stomach pain or upset;

constipation;

skin rash, hair loss, changes in skin or hair color; or

headache, joint or muscle pain.

----- Original Message -----

From:

..

for art

----- Original Message ----- From: Nancie Barnett

deifspiritmsn

Sent: Wednesday, October 17, 2007 6:48 PM

Subject: Clinical Information from Epocrates Online (Premium Version)

The clinical content below is part of the Epocrates® Online database.For a free subscription to Epocrates Online, visit us at http://www.epocrates.com/products/online/index.html.

Message From Senderfor art

Drug

Sutentsunitinib

Adult Dosing

chemotherapy[uses, dosing may vary]Info: for all uses, refer to institution protocols and pkg insert prior to prescribinggastrointestinal stromal tumor, refractory[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal cell CA, advanced[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal dosing[not defined]hepatic dosing[not defined]Peds Dosing

This information is currently unavailable or not applicable for this drug.Contraindications/Cautionshypersens. to drug/class/compon.see Drug Interactionspregnancy not recommendedbreastfeeding not recommendedCHFcaution if thromboembolic event w/in 1ycaution if ischemic cardiac event w/in 1ycaution if HTNcaution if recent surgery/traumacaution if infectionDrug InteractionsContraindicated[atazanavir] contraindicated: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Avoid/Use Alternative[amprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [aprepitant] use alternative: combo may incr. or decr. sunitinib levels (hepatic metab. altered) [barbiturates] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bexarotene] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bosentan] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [carbamazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [clarithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [conivaptan] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [darunavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [delavirdine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dexamethasone] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz/emtricitabine/tenofovir] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo w/ efavirenz may decr. sunitinib levels, efficacy (hepatic metab. induced) [fluvoxamine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fosamprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [grapefruit] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [griseofulvins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [imatinib] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [indinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [itraconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [ketoconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [lopinavir/ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nefazodone] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nelfinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nevirapine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [oxcarbazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [phenytoins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [posaconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [rifabutin] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifampins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifapentine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [saquinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [st. 's wort] avoid concurrent use: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [telithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [tipranavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [voriconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Monitor/Modify Tx[growth hormone] caution advised: combo may decr. sunitinib levels, efficacy (hepatic metab. possibly induced) [lapatinib] caution advised, consider lower sunitinib doses: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Caution Advised[amiodarone] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dasatinib] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fluconazole] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [octreotide] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. possibly inhibited) [ranolazine] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Adverse ReactionsSerious ReactionsCHFMIHTN, severethromboembolismhemorrhage, majorneutropeniathrombocytopeniaGI perforation (rare)pancreatitis (rare)hypothyroidismadrenal insufficiencyadrenal toxicity (animal studies)seizures (rare)Common Reactionsneutropeniaelevated ALT, AST, bilirubinlymphopeniathrombocytopeniadiarrheaabdominal painanorexianausea/vomitingskin discolorationmucositis/stomatitiselevated amylase/lipaseelevated alk phosastheniataste changesconstipationbleedingfeverHTNrashhand-foot syndromemyalgia/arthralgiahypokalemiaheadacheback paindecreased LVEFdyspneahypernatremiaanemiaelevated CrcoughSafety MonitoringPregnancy: DLactation: Possibly UnsafeMonitoring Parameters: CBC, Plt, serum chemistries (incl. PO4) prior to each cycle; LVEF at baseline, then if cardiac risk factors cont. periodically; BPPharmacologyMetabolism: liver; CYP450: 3A4 substrate; Info: active metaboliteExcretion: feces 61%, urine 16%; Half-life: 40-60h (parent), 80-110h (metabolite)Class: Other Oncologics Mechanism Of Action: inhibits phosphorylation of multiple tyrosine kinases, resulting in anti-cancer and anti-angiogenesis effects Manufacturer/PricingManufacturer: Pfizer Inc.DEA/FDA: Rx

Patient Education

Generic Name:

sunitinib

Pronounced:

soo NIT in ib

What is the most important information I should know about sunitinib?

Do not use this medication if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.

Before using sunitinib, tell your doctor if you have high blood pressure, a thyroid disorder, a heart rhythm disorder, or if you have ever had a heart attack, congestive heart failure, a stroke, or blood clots.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Stop using sunitinib and call your doctor at once if you have chest pain, shortness or breath, sudden numbness or weakness, sudden headache or vision problems, or any unusual bruising or bleeding.

What is sunitinib?

Sunitinib is a cancer medicine that helps the body slow down the growth and reproduction of certain cells, including tumor cells.

Sunitinib is used to treat certain types of advanced or progressive tumors of the digestive system or the kidneys.

Sunitinib may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before using sunitinib?

Before using sunitinib, tell your doctor if you have:

high blood pressure;

a thyroid disorder;

a heart rhythm disorder;

a personal or family history of "Long QT syndrome";

a history of heart attack or congestive heart failure; or

a history of stroke, blood clots, coronary artery disease, bypass graft surgery, or transient ischemic attack (TIA).

If you have any of these conditions, you may not be able to use sunitinib or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category D: This medication can cause harm to an unborn baby. Do not use sunitinib if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.

It is not known if sunitinib passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take sunitinib?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Sunitinib is usually taken once every day for 4 weeks, followed by 2 weeks off the drug. Your doctor will determine how many complete treatment cycles you need based on your condition.

Sunitinib may be taken with or without food.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Store sunitinib at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a sunitinib overdose may include muscle weakness, shaking or chills, and stomach pain.

What should I avoid while taking sunitinib?

Avoid taking an herbal supplement containing St. 's wort at the same time you are taking sunitinib.

What are the possible side effects of sunitinib?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using sunitinib and call your doctor at once if you have any of these serious side effects:

chest pain, general ill feeling;

uneven heart rate;

feeling short of breath, even with mild exertion;

swelling of your ankles or feet;

weakness, tired feeling, nausea, loss of appetite, weight loss;

sudden numbness or weakness, especially on one side of the body;

sudden headache, confusion, problems with vision, speech, or balance;

redness, tenderness, sunburn-like peeling of the palms of your hands or the soles of your feet;

bloody, or black, tarry stools;

coughing up blood or vomit that looks like coffee grounds;

easy bruising or bleeding, unusual weakness; or

white patches or sores inside your mouth or on your lips.

Keep using sunitinib and talk with your doctor if you have any of these less serious side effects:

unusual or unpleasant taste in the mouth;

nausea, vomiting, stomach pain or upset;

diarrhea or constipation;

skin rash, hair loss, changes in skin or hair color; or

headache, joint or muscle pain.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect sunitinib?

Before taking sunitinib, tell your doctor if you are using any of the following drugs:

ketoconazole (Nizoral), itraconazole (Sporanox), voriconazole (VFend);

dexamethasone (Decadron, Dexacort);

nefazodone (Serzone);

seizure medicines such as carbamazepine (Carbatrol, Tegretol), phenytoin (Dilantin), or phenobarbital (Luminal, Solfoton);

rifampin (Rifadin, Rimactane), rifabutin (Mycobutin), rifapentin (Priftin);

clarithromycin (Biaxin), telithromycin (Ketek); or

HIV medicines such as atazanavir (Reyataz), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Invirase, Fortovase).

If you are using any of these drugs, you may not be able to take sunitinib, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect sunitinib. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist has information about sunitinib written for health professionals that you may read.

What does my medication look like?

Sunitinib is available with a prescription under the brand name Sutent. Other brand or generic forms may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

Sutent 12.5 mg--orange capsule

Sutent 25 mg--caramel and orange capsule

Sutent 50 mg--caramel capsule

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Pill Pictures

This information is currently unavailable or not applicable for this drug.

Substantial effort has been made to ensure that the information provided by Epocrates is accurate and up-to-date, but this information is not intended to cover all possible uses, precautions, or other considerations relating to the therapies covered. Epocrates does not advocate or endorse the use of any drug or other therapy and does not diagnose patients. Healthcare professionals should use their professional judgment in using this information, and this information should not be considered a substitute for the care and professional judgment provided by a licensed healthcare practitioner. This information if provided on an "as is" basis, and Epocrates and its affiliates, agents and licensors assume no responsibility for any aspect of healthcare administered with the aid of this information or any other use of the information.

Receipt of this message does not mean that you have been opted into Epocrates email. If you wish to ensure that you do not receive any further emails of this type from Epocrates, please email unsubscribeonline (DOT) epocrates.com.

No virus found in this incoming message.Checked by AVG Free Edition. Version: 7.5.488 / Virus Database: 269.14.13/1075 - Release Date: 10/17/2007 9:38 AM

October 18, 2007

Art, remember the kidney cancer is almost gone. You still need to find a new doctor though. Your symptoms are horrible, but they won't last forever. Always find the positive in everything. I will be signing off the groups soon for the night. I have some files to work on. I hope you get a good night sleep. I will say prayers. Remember to open you heart chakra to receive healing from Reiki practitioners. Imagine the area where your heart is, as a big flower like a Lotus. Imagine the flower petals opening so that they are flat. Then remember to close the petals so that they are standing straight up, before you go to sleep. I will send prayers and Light to you. Blessings, Joy

----- Original Message -----

From: Art3

Sent: Wednesday, October 17, 2007 11:24 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

I take it 3 weeks off 1 week and mine is 50MG.

I have abdominal painanorexianausea/vomitingskin discolorationtaste changesconstipationRash

back pain

swelling of your ankles or feet;

weakness, tired feeling, nausea, loss of appetite, weight loss;

sudden numbness or weakness, especially on one side of the body;

redness, tenderness, sunburn-like peeling of the palms of your hands or the soles of your feet;

bloody, or black, tarry stools;

white patches or sores inside your mouth or on your lips.

unusual or unpleasant taste in the mouth;

nausea,stomach pain or upset;

constipation;

skin rash, hair loss, changes in skin or hair color; or

headache, joint or muscle pain.

----- Original Message -----

From:

..

for art

----- Original Message ----- From: Nancie Barnett

deifspiritmsn

Sent: Wednesday, October 17, 2007 6:48 PM

Subject: Clinical Information from Epocrates Online (Premium Version)

The clinical content below is part of the Epocrates® Online database.For a free subscription to Epocrates Online, visit us at http://www.epocrates.com/products/online/index.html.

Message From Senderfor art

Drug

Sutentsunitinib

Adult Dosing

chemotherapy[uses, dosing may vary]Info: for all uses, refer to institution protocols and pkg insert prior to prescribinggastrointestinal stromal tumor, refractory[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal cell CA, advanced[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal dosing[not defined]hepatic dosing[not defined]Peds Dosing

This information is currently unavailable or not applicable for this drug.Contraindications/Cautionshypersens. to drug/class/compon.see Drug Interactionspregnancy not recommendedbreastfeeding not recommendedCHFcaution if thromboembolic event w/in 1ycaution if ischemic cardiac event w/in 1ycaution if HTNcaution if recent surgery/traumacaution if infectionDrug InteractionsContraindicated[atazanavir] contraindicated: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Avoid/Use Alternative[amprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [aprepitant] use alternative: combo may incr. or decr. sunitinib levels (hepatic metab. altered) [barbiturates] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bexarotene] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bosentan] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [carbamazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [clarithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [conivaptan] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [darunavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [delavirdine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dexamethasone] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz/emtricitabine/tenofovir] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo w/ efavirenz may decr. sunitinib levels, efficacy (hepatic metab. induced) [fluvoxamine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fosamprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [grapefruit] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [griseofulvins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [imatinib] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [indinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [itraconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [ketoconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [lopinavir/ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nefazodone] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nelfinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nevirapine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [oxcarbazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [phenytoins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [posaconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [rifabutin] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifampins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifapentine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [saquinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [st. 's wort] avoid concurrent use: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [telithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [tipranavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [voriconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Monitor/Modify Tx[growth hormone] caution advised: combo may decr. sunitinib levels, efficacy (hepatic metab. possibly induced) [lapatinib] caution advised, consider lower sunitinib doses: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Caution Advised[amiodarone] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dasatinib] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fluconazole] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [octreotide] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. possibly inhibited) [ranolazine] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Adverse ReactionsSerious ReactionsCHFMIHTN, severethromboembolismhemorrhage, majorneutropeniathrombocytopeniaGI perforation (rare)pancreatitis (rare)hypothyroidismadrenal insufficiencyadrenal toxicity (animal studies)seizures (rare)Common Reactionsneutropeniaelevated ALT, AST, bilirubinlymphopeniathrombocytopeniadiarrheaabdominal painanorexianausea/vomitingskin discolorationmucositis/stomatitiselevated amylase/lipaseelevated alk phosastheniataste changesconstipationbleedingfeverHTNrashhand-foot syndromemyalgia/arthralgiahypokalemiaheadacheback paindecreased LVEFdyspneahypernatremiaanemiaelevated CrcoughSafety MonitoringPregnancy: DLactation: Possibly UnsafeMonitoring Parameters: CBC, Plt, serum chemistries (incl. PO4) prior to each cycle; LVEF at baseline, then if cardiac risk factors cont. periodically; BPPharmacologyMetabolism: liver; CYP450: 3A4 substrate; Info: active metaboliteExcretion: feces 61%, urine 16%; Half-life: 40-60h (parent), 80-110h (metabolite)Class: Other Oncologics Mechanism Of Action: inhibits phosphorylation of multiple tyrosine kinases, resulting in anti-cancer and anti-angiogenesis effects Manufacturer/PricingManufacturer: Pfizer Inc.DEA/FDA: Rx

Patient Education

Generic Name:

sunitinib

Pronounced:

soo NIT in ib

What is the most important information I should know about sunitinib?

Do not use this medication if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.

Before using sunitinib, tell your doctor if you have high blood pressure, a thyroid disorder, a heart rhythm disorder, or if you have ever had a heart attack, congestive heart failure, a stroke, or blood clots.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Stop using sunitinib and call your doctor at once if you have chest pain, shortness or breath, sudden numbness or weakness, sudden headache or vision problems, or any unusual bruising or bleeding.

What is sunitinib?

Sunitinib is a cancer medicine that helps the body slow down the growth and reproduction of certain cells, including tumor cells.

Sunitinib is used to treat certain types of advanced or progressive tumors of the digestive system or the kidneys.

Sunitinib may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before using sunitinib?

Before using sunitinib, tell your doctor if you have:

high blood pressure;

a thyroid disorder;

a heart rhythm disorder;

a personal or family history of "Long QT syndrome";

a history of heart attack or congestive heart failure; or

a history of stroke, blood clots, coronary artery disease, bypass graft surgery, or transient ischemic attack (TIA).

If you have any of these conditions, you may not be able to use sunitinib or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category D: This medication can cause harm to an unborn baby. Do not use sunitinib if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.

It is not known if sunitinib passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take sunitinib?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Sunitinib is usually taken once every day for 4 weeks, followed by 2 weeks off the drug. Your doctor will determine how many complete treatment cycles you need based on your condition.

Sunitinib may be taken with or without food.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Store sunitinib at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a sunitinib overdose may include muscle weakness, shaking or chills, and stomach pain.

What should I avoid while taking sunitinib?

Avoid taking an herbal supplement containing St. 's wort at the same time you are taking sunitinib.

What are the possible side effects of sunitinib?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using sunitinib and call your doctor at once if you have any of these serious side effects:

chest pain, general ill feeling;

uneven heart rate;

feeling short of breath, even with mild exertion;

swelling of your ankles or feet;

weakness, tired feeling, nausea, loss of appetite, weight loss;

sudden numbness or weakness, especially on one side of the body;

sudden headache, confusion, problems with vision, speech, or balance;

redness, tenderness, sunburn-like peeling of the palms of your hands or the soles of your feet;

bloody, or black, tarry stools;

coughing up blood or vomit that looks like coffee grounds;

easy bruising or bleeding, unusual weakness; or

white patches or sores inside your mouth or on your lips.

Keep using sunitinib and talk with your doctor if you have any of these less serious side effects:

unusual or unpleasant taste in the mouth;

nausea, vomiting, stomach pain or upset;

diarrhea or constipation;

skin rash, hair loss, changes in skin or hair color; or

headache, joint or muscle pain.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect sunitinib?

Before taking sunitinib, tell your doctor if you are using any of the following drugs:

ketoconazole (Nizoral), itraconazole (Sporanox), voriconazole (VFend);

dexamethasone (Decadron, Dexacort);

nefazodone (Serzone);

seizure medicines such as carbamazepine (Carbatrol, Tegretol), phenytoin (Dilantin), or phenobarbital (Luminal, Solfoton);

rifampin (Rifadin, Rimactane), rifabutin (Mycobutin), rifapentin (Priftin);

clarithromycin (Biaxin), telithromycin (Ketek); or

HIV medicines such as atazanavir (Reyataz), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Invirase, Fortovase).

If you are using any of these drugs, you may not be able to take sunitinib, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect sunitinib. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist has information about sunitinib written for health professionals that you may read.

What does my medication look like?

Sunitinib is available with a prescription under the brand name Sutent. Other brand or generic forms may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

Sutent 12.5 mg--orange capsule

Sutent 25 mg--caramel and orange capsule

Sutent 50 mg--caramel capsule

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Pill Pictures

This information is currently unavailable or not applicable for this drug.

Substantial effort has been made to ensure that the information provided by Epocrates is accurate and up-to-date, but this information is not intended to cover all possible uses, precautions, or other considerations relating to the therapies covered. Epocrates does not advocate or endorse the use of any drug or other therapy and does not diagnose patients. Healthcare professionals should use their professional judgment in using this information, and this information should not be considered a substitute for the care and professional judgment provided by a licensed healthcare practitioner. This information if provided on an "as is" basis, and Epocrates and its affiliates, agents and licensors assume no responsibility for any aspect of healthcare administered with the aid of this information or any other use of the information.

Receipt of this message does not mean that you have been opted into Epocrates email. If you wish to ensure that you do not receive any further emails of this type from Epocrates, please email unsubscribeonline (DOT) epocrates.com.

No virus found in this incoming message.Checked by AVG Free Edition. Version: 7.5.488 / Virus Database: 269.14.13/1075 - Release Date: 10/17/2007 9:38 AM

October 18, 2007

have you told him/her your side effects?? sometimes you have to just live with the side effects. it is not fun that is for sure!

I was on chemo for 15 + years total I took cytoxin and decadron every month for 14 years straight without a break, then took a break and went back on it for 16 months.

have you ever thought of trying acupuncture for your side effects? or massage therapy?

----- Original Message -----

From: Art3

Sent: Wednesday, October 17, 2007 8:24 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

I take it 3 weeks off 1 week and mine is 50MG.

I have abdominal painanorexianausea/vomitingskin discolorationtaste changesconstipationRash

back pain

swelling of your ankles or feet;

weakness, tired feeling, nausea, loss of appetite, weight loss;

sudden numbness or weakness, especially on one side of the body;

redness, tenderness, sunburn-like peeling of the palms of your hands or the soles of your feet;

bloody, or black, tarry stools;

white patches or sores inside your mouth or on your lips.

unusual or unpleasant taste in the mouth;

nausea,stomach pain or upset;

constipation;

skin rash, hair loss, changes in skin or hair color; or

headache, joint or muscle pain.

----- Original Message -----

From:

..

for art

----- Original Message ----- From: Nancie Barnett

deifspiritmsn

Sent: Wednesday, October 17, 2007 6:48 PM

Subject: Clinical Information from Epocrates Online (Premium Version)

The clinical content below is part of the Epocrates® Online database.For a free subscription to Epocrates Online, visit us at http://www.epocrates.com/products/online/index.html.

Message From Senderfor art

Drug

Sutentsunitinib

Adult Dosing

chemotherapy[uses, dosing may vary]Info: for all uses, refer to institution protocols and pkg insert prior to prescribinggastrointestinal stromal tumor, refractory[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal cell CA, advanced[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal dosing[not defined]hepatic dosing[not defined]Peds Dosing

This information is currently unavailable or not applicable for this drug.Contraindications/Cautionshypersens. to drug/class/compon.see Drug Interactionspregnancy not recommendedbreastfeeding not recommendedCHFcaution if thromboembolic event w/in 1ycaution if ischemic cardiac event w/in 1ycaution if HTNcaution if recent surgery/traumacaution if infectionDrug InteractionsContraindicated[atazanavir] contraindicated: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Avoid/Use Alternative[amprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [aprepitant] use alternative: combo may incr. or decr. sunitinib levels (hepatic metab. altered) [barbiturates] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bexarotene] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bosentan] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [carbamazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [clarithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [conivaptan] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [darunavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [delavirdine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dexamethasone] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz/emtricitabine/tenofovir] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo w/ efavirenz may decr. sunitinib levels, efficacy (hepatic metab. induced) [fluvoxamine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fosamprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [grapefruit] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [griseofulvins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [imatinib] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [indinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [itraconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [ketoconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [lopinavir/ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nefazodone] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nelfinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nevirapine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [oxcarbazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [phenytoins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [posaconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [rifabutin] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifampins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifapentine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [saquinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [st. 's wort] avoid concurrent use: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [telithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [tipranavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [voriconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Monitor/Modify Tx[growth hormone] caution advised: combo may decr. sunitinib levels, efficacy (hepatic metab. possibly induced) [lapatinib] caution advised, consider lower sunitinib doses: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Caution Advised[amiodarone] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dasatinib] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fluconazole] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [octreotide] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. possibly inhibited) [ranolazine] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Adverse ReactionsSerious ReactionsCHFMIHTN, severethromboembolismhemorrhage, majorneutropeniathrombocytopeniaGI perforation (rare)pancreatitis (rare)hypothyroidismadrenal insufficiencyadrenal toxicity (animal studies)seizures (rare)Common Reactionsneutropeniaelevated ALT, AST, bilirubinlymphopeniathrombocytopeniadiarrheaabdominal painanorexianausea/vomitingskin discolorationmucositis/stomatitiselevated amylase/lipaseelevated alk phosastheniataste changesconstipationbleedingfeverHTNrashhand-foot syndromemyalgia/arthralgiahypokalemiaheadacheback paindecreased LVEFdyspneahypernatremiaanemiaelevated CrcoughSafety MonitoringPregnancy: DLactation: Possibly UnsafeMonitoring Parameters: CBC, Plt, serum chemistries (incl. PO4) prior to each cycle; LVEF at baseline, then if cardiac risk factors cont. periodically; BPPharmacologyMetabolism: liver; CYP450: 3A4 substrate; Info: active metaboliteExcretion: feces 61%, urine 16%; Half-life: 40-60h (parent), 80-110h (metabolite)Class: Other Oncologics Mechanism Of Action: inhibits phosphorylation of multiple tyrosine kinases, resulting in anti-cancer and anti-angiogenesis effects Manufacturer/PricingManufacturer: Pfizer Inc.DEA/FDA: Rx

Patient Education

Generic Name:

sunitinib

Pronounced:

soo NIT in ib

What is the most important information I should know about sunitinib?

Do not use this medication if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.

Before using sunitinib, tell your doctor if you have high blood pressure, a thyroid disorder, a heart rhythm disorder, or if you have ever had a heart attack, congestive heart failure, a stroke, or blood clots.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Stop using sunitinib and call your doctor at once if you have chest pain, shortness or breath, sudden numbness or weakness, sudden headache or vision problems, or any unusual bruising or bleeding.

What is sunitinib?

Sunitinib is a cancer medicine that helps the body slow down the growth and reproduction of certain cells, including tumor cells.

Sunitinib is used to treat certain types of advanced or progressive tumors of the digestive system or the kidneys.

Sunitinib may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before using sunitinib?

Before using sunitinib, tell your doctor if you have:

high blood pressure;

a thyroid disorder;

a heart rhythm disorder;

a personal or family history of "Long QT syndrome";

a history of heart attack or congestive heart failure; or

a history of stroke, blood clots, coronary artery disease, bypass graft surgery, or transient ischemic attack (TIA).

If you have any of these conditions, you may not be able to use sunitinib or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category D: This medication can cause harm to an unborn baby. Do not use sunitinib if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.

It is not known if sunitinib passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take sunitinib?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Sunitinib is usually taken once every day for 4 weeks, followed by 2 weeks off the drug. Your doctor will determine how many complete treatment cycles you need based on your condition.

Sunitinib may be taken with or without food.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Store sunitinib at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a sunitinib overdose may include muscle weakness, shaking or chills, and stomach pain.

What should I avoid while taking sunitinib?

Avoid taking an herbal supplement containing St. 's wort at the same time you are taking sunitinib.

What are the possible side effects of sunitinib?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using sunitinib and call your doctor at once if you have any of these serious side effects:

chest pain, general ill feeling;

uneven heart rate;

feeling short of breath, even with mild exertion;

swelling of your ankles or feet;

weakness, tired feeling, nausea, loss of appetite, weight loss;

sudden numbness or weakness, especially on one side of the body;

sudden headache, confusion, problems with vision, speech, or balance;

redness, tenderness, sunburn-like peeling of the palms of your hands or the soles of your feet;

bloody, or black, tarry stools;

coughing up blood or vomit that looks like coffee grounds;

easy bruising or bleeding, unusual weakness; or

white patches or sores inside your mouth or on your lips.

Keep using sunitinib and talk with your doctor if you have any of these less serious side effects:

unusual or unpleasant taste in the mouth;

nausea, vomiting, stomach pain or upset;

diarrhea or constipation;

skin rash, hair loss, changes in skin or hair color; or

headache, joint or muscle pain.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect sunitinib?

Before taking sunitinib, tell your doctor if you are using any of the following drugs:

ketoconazole (Nizoral), itraconazole (Sporanox), voriconazole (VFend);

dexamethasone (Decadron, Dexacort);

nefazodone (Serzone);

seizure medicines such as carbamazepine (Carbatrol, Tegretol), phenytoin (Dilantin), or phenobarbital (Luminal, Solfoton);

rifampin (Rifadin, Rimactane), rifabutin (Mycobutin), rifapentin (Priftin);

clarithromycin (Biaxin), telithromycin (Ketek); or

HIV medicines such as atazanavir (Reyataz), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Invirase, Fortovase).

If you are using any of these drugs, you may not be able to take sunitinib, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect sunitinib. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist has information about sunitinib written for health professionals that you may read.

What does my medication look like?

Sunitinib is available with a prescription under the brand name Sutent. Other brand or generic forms may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

Sutent 12.5 mg--orange capsule

Sutent 25 mg--caramel and orange capsule

Sutent 50 mg--caramel capsule

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Pill Pictures

This information is currently unavailable or not applicable for this drug.

Substantial effort has been made to ensure that the information provided by Epocrates is accurate and up-to-date, but this information is not intended to cover all possible uses, precautions, or other considerations relating to the therapies covered. Epocrates does not advocate or endorse the use of any drug or other therapy and does not diagnose patients. Healthcare professionals should use their professional judgment in using this information, and this information should not be considered a substitute for the care and professional judgment provided by a licensed healthcare practitioner. This information if provided on an "as is" basis, and Epocrates and its affiliates, agents and licensors assume no responsibility for any aspect of healthcare administered with the aid of this information or any other use of the information.

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No virus found in this incoming message.Checked by AVG Free Edition. Version: 7.5.488 / Virus Database: 269.14.13/1075 - Release Date: 10/17/2007 9:38 AM

October 18, 2007

I need to lose 133 pounds also fast.

My doctor said my symtoms are from the vitamins and stuff.

My sister was suppose to pick me up tonight to go to another Reiki healing but she never showed up/

http://www.roswellpark.org/Site/Home/MMNR/Press/The_Best_Doctors_In_America_at_RPCI

This is the cancer hospital I go to.

----- Original Message -----

From: Joyce Hudson

Sent: Wednesday, October 17, 2007 8:42 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

Art, remember the kidney cancer is almost gone. You still need to find a new doctor though. Your symptoms are horrible, but they won't last forever. Always find the positive in everything. I will be signing off the groups soon for the night. I have some files to work on. I hope you get a good night sleep. I will say prayers. Remember to open you heart chakra to receive healing from Reiki practitioners. Imagine the area where your heart is, as a big flower like a Lotus. Imagine the flower petals opening so that they are flat. Then remember to close the petals so that they are standing straight up, before you go to sleep. I will send prayers and Light to you. Blessings, Joy

----- Original Message -----

From: Art3

Sent: Wednesday, October 17, 2007 11:24 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

I take it 3 weeks off 1 week and mine is 50MG.

I have abdominal painanorexianausea/vomitingskin discolorationtaste changesconstipationRash

back pain

swelling of your ankles or feet;

weakness, tired feeling, nausea, loss of appetite, weight loss;

sudden numbness or weakness, especially on one side of the body;

redness, tenderness, sunburn-like peeling of the palms of your hands or the soles of your feet;

bloody, or black, tarry stools;

white patches or sores inside your mouth or on your lips.

unusual or unpleasant taste in the mouth;

nausea,stomach pain or upset;

constipation;

skin rash, hair loss, changes in skin or hair color; or

headache, joint or muscle pain.

----- Original Message -----

From:

..

for art

----- Original Message ----- From: Nancie Barnett

deifspiritmsn

Sent: Wednesday, October 17, 2007 6:48 PM

Subject: Clinical Information from Epocrates Online (Premium Version)

The clinical content below is part of the Epocrates® Online database.For a free subscription to Epocrates Online, visit us at http://www.epocrates.com/products/online/index.html.

Message From Senderfor art

Drug

Sutentsunitinib

Adult Dosing

chemotherapy[uses, dosing may vary]Info: for all uses, refer to institution protocols and pkg insert prior to prescribinggastrointestinal stromal tumor, refractory[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal cell CA, advanced[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal dosing[not defined]hepatic dosing[not defined]Peds Dosing

This information is currently unavailable or not applicable for this drug.Contraindications/Cautionshypersens. to drug/class/compon.see Drug Interactionspregnancy not recommendedbreastfeeding not recommendedCHFcaution if thromboembolic event w/in 1ycaution if ischemic cardiac event w/in 1ycaution if HTNcaution if recent surgery/traumacaution if infectionDrug InteractionsContraindicated[atazanavir] contraindicated: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Avoid/Use Alternative[amprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [aprepitant] use alternative: combo may incr. or decr. sunitinib levels (hepatic metab. altered) [barbiturates] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bexarotene] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bosentan] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [carbamazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [clarithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [conivaptan] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [darunavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [delavirdine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dexamethasone] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz/emtricitabine/tenofovir] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo w/ efavirenz may decr. sunitinib levels, efficacy (hepatic metab. induced) [fluvoxamine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fosamprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [grapefruit] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [griseofulvins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [imatinib] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [indinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [itraconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [ketoconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [lopinavir/ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nefazodone] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nelfinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nevirapine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [oxcarbazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [phenytoins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [posaconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [rifabutin] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifampins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifapentine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [saquinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [st. 's wort] avoid concurrent use: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [telithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [tipranavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [voriconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Monitor/Modify Tx[growth hormone] caution advised: combo may decr. sunitinib levels, efficacy (hepatic metab. possibly induced) [lapatinib] caution advised, consider lower sunitinib doses: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Caution Advised[amiodarone] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dasatinib] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fluconazole] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [octreotide] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. possibly inhibited) [ranolazine] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Adverse ReactionsSerious ReactionsCHFMIHTN, severethromboembolismhemorrhage, majorneutropeniathrombocytopeniaGI perforation (rare)pancreatitis (rare)hypothyroidismadrenal insufficiencyadrenal toxicity (animal studies)seizures (rare)Common Reactionsneutropeniaelevated ALT, AST, bilirubinlymphopeniathrombocytopeniadiarrheaabdominal painanorexianausea/vomitingskin discolorationmucositis/stomatitiselevated amylase/lipaseelevated alk phosastheniataste changesconstipationbleedingfeverHTNrashhand-foot syndromemyalgia/arthralgiahypokalemiaheadacheback paindecreased LVEFdyspneahypernatremiaanemiaelevated CrcoughSafety MonitoringPregnancy: DLactation: Possibly UnsafeMonitoring Parameters: CBC, Plt, serum chemistries (incl. PO4) prior to each cycle; LVEF at baseline, then if cardiac risk factors cont. periodically; BPPharmacologyMetabolism: liver; CYP450: 3A4 substrate; Info: active metaboliteExcretion: feces 61%, urine 16%; Half-life: 40-60h (parent), 80-110h (metabolite)Class: Other Oncologics Mechanism Of Action: inhibits phosphorylation of multiple tyrosine kinases, resulting in anti-cancer and anti-angiogenesis effects Manufacturer/PricingManufacturer: Pfizer Inc.DEA/FDA: Rx

Patient Education

Generic Name:

sunitinib

Pronounced:

soo NIT in ib

What is the most important information I should know about sunitinib?

Do not use this medication if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.

Before using sunitinib, tell your doctor if you have high blood pressure, a thyroid disorder, a heart rhythm disorder, or if you have ever had a heart attack, congestive heart failure, a stroke, or blood clots.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Stop using sunitinib and call your doctor at once if you have chest pain, shortness or breath, sudden numbness or weakness, sudden headache or vision problems, or any unusual bruising or bleeding.

What is sunitinib?

Sunitinib is a cancer medicine that helps the body slow down the growth and reproduction of certain cells, including tumor cells.

Sunitinib is used to treat certain types of advanced or progressive tumors of the digestive system or the kidneys.

Sunitinib may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before using sunitinib?

Before using sunitinib, tell your doctor if you have:

high blood pressure;

a thyroid disorder;

a heart rhythm disorder;

a personal or family history of "Long QT syndrome";

a history of heart attack or congestive heart failure; or

a history of stroke, blood clots, coronary artery disease, bypass graft surgery, or transient ischemic attack (TIA).

If you have any of these conditions, you may not be able to use sunitinib or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category D: This medication can cause harm to an unborn baby. Do not use sunitinib if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.

It is not known if sunitinib passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take sunitinib?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Sunitinib is usually taken once every day for 4 weeks, followed by 2 weeks off the drug. Your doctor will determine how many complete treatment cycles you need based on your condition.

Sunitinib may be taken with or without food.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Store sunitinib at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a sunitinib overdose may include muscle weakness, shaking or chills, and stomach pain.

What should I avoid while taking sunitinib?

Avoid taking an herbal supplement containing St. 's wort at the same time you are taking sunitinib.

What are the possible side effects of sunitinib?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using sunitinib and call your doctor at once if you have any of these serious side effects:

chest pain, general ill feeling;

uneven heart rate;

feeling short of breath, even with mild exertion;

swelling of your ankles or feet;

weakness, tired feeling, nausea, loss of appetite, weight loss;

sudden numbness or weakness, especially on one side of the body;

sudden headache, confusion, problems with vision, speech, or balance;

redness, tenderness, sunburn-like peeling of the palms of your hands or the soles of your feet;

bloody, or black, tarry stools;

coughing up blood or vomit that looks like coffee grounds;

easy bruising or bleeding, unusual weakness; or

white patches or sores inside your mouth or on your lips.

Keep using sunitinib and talk with your doctor if you have any of these less serious side effects:

unusual or unpleasant taste in the mouth;

nausea, vomiting, stomach pain or upset;

diarrhea or constipation;

skin rash, hair loss, changes in skin or hair color; or

headache, joint or muscle pain.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect sunitinib?

Before taking sunitinib, tell your doctor if you are using any of the following drugs:

ketoconazole (Nizoral), itraconazole (Sporanox), voriconazole (VFend);

dexamethasone (Decadron, Dexacort);

nefazodone (Serzone);

seizure medicines such as carbamazepine (Carbatrol, Tegretol), phenytoin (Dilantin), or phenobarbital (Luminal, Solfoton);

rifampin (Rifadin, Rimactane), rifabutin (Mycobutin), rifapentin (Priftin);

clarithromycin (Biaxin), telithromycin (Ketek); or

HIV medicines such as atazanavir (Reyataz), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Invirase, Fortovase).

If you are using any of these drugs, you may not be able to take sunitinib, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect sunitinib. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist has information about sunitinib written for health professionals that you may read.

What does my medication look like?

Sunitinib is available with a prescription under the brand name Sutent. Other brand or generic forms may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

Sutent 12.5 mg--orange capsule

Sutent 25 mg--caramel and orange capsule

Sutent 50 mg--caramel capsule

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Pill Pictures

This information is currently unavailable or not applicable for this drug.

Substantial effort has been made to ensure that the information provided by Epocrates is accurate and up-to-date, but this information is not intended to cover all possible uses, precautions, or other considerations relating to the therapies covered. Epocrates does not advocate or endorse the use of any drug or other therapy and does not diagnose patients. Healthcare professionals should use their professional judgment in using this information, and this information should not be considered a substitute for the care and professional judgment provided by a licensed healthcare practitioner. This information if provided on an "as is" basis, and Epocrates and its affiliates, agents and licensors assume no responsibility for any aspect of healthcare administered with the aid of this information or any other use of the information.

Receipt of this message does not mean that you have been opted into Epocrates email. If you wish to ensure that you do not receive any further emails of this type from Epocrates, please email unsubscribeonline (DOT) epocrates.com.

No virus found in this incoming message.Checked by AVG Free Edition. Version: 7.5.488 / Virus Database: 269.14.13/1075 - Release Date: 10/17/2007 9:38 AM

October 18, 2007

find an naturapthic provider and get a 2nd opinion. look up the wellness community organization in your state- it is a cancer support group that may have alternative medicine resources.

----- Original Message -----

From: Art3

Sent: Wednesday, October 17, 2007 9:46 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

I need to lose 133 pounds also fast.

My doctor said my symtoms are from the vitamins and stuff.

My sister was suppose to pick me up tonight to go to another Reiki healing but she never showed up/

http://www.roswellpark.org/Site/Home/MMNR/Press/The_Best_Doctors_In_America_at_RPCI

This is the cancer hospital I go to.

----- Original Message -----

From: Joyce Hudson

Sent: Wednesday, October 17, 2007 8:42 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

Art, remember the kidney cancer is almost gone. You still need to find a new doctor though. Your symptoms are horrible, but they won't last forever. Always find the positive in everything. I will be signing off the groups soon for the night. I have some files to work on. I hope you get a good night sleep. I will say prayers. Remember to open you heart chakra to receive healing from Reiki practitioners. Imagine the area where your heart is, as a big flower like a Lotus. Imagine the flower petals opening so that they are flat. Then remember to close the petals so that they are standing straight up, before you go to sleep. I will send prayers and Light to you. Blessings, Joy

----- Original Message -----

From: Art3

Sent: Wednesday, October 17, 2007 11:24 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

I take it 3 weeks off 1 week and mine is 50MG.

I have abdominal painanorexianausea/vomitingskin discolorationtaste changesconstipationRash

back pain

swelling of your ankles or feet;

weakness, tired feeling, nausea, loss of appetite, weight loss;

sudden numbness or weakness, especially on one side of the body;

redness, tenderness, sunburn-like peeling of the palms of your hands or the soles of your feet;

bloody, or black, tarry stools;

white patches or sores inside your mouth or on your lips.

unusual or unpleasant taste in the mouth;

nausea,stomach pain or upset;

constipation;

skin rash, hair loss, changes in skin or hair color; or

headache, joint or muscle pain.

----- Original Message -----

From:

..

for art

----- Original Message ----- From: Nancie Barnett

deifspiritmsn

Sent: Wednesday, October 17, 2007 6:48 PM

Subject: Clinical Information from Epocrates Online (Premium Version)

The clinical content below is part of the Epocrates® Online database.For a free subscription to Epocrates Online, visit us at http://www.epocrates.com/products/online/index.html.

Message From Senderfor art

Drug

Sutentsunitinib

Adult Dosing

chemotherapy[uses, dosing may vary]Info: for all uses, refer to institution protocols and pkg insert prior to prescribinggastrointestinal stromal tumor, refractory[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal cell CA, advanced[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal dosing[not defined]hepatic dosing[not defined]Peds Dosing

This information is currently unavailable or not applicable for this drug.Contraindications/Cautionshypersens. to drug/class/compon.see Drug Interactionspregnancy not recommendedbreastfeeding not recommendedCHFcaution if thromboembolic event w/in 1ycaution if ischemic cardiac event w/in 1ycaution if HTNcaution if recent surgery/traumacaution if infectionDrug InteractionsContraindicated[atazanavir] contraindicated: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Avoid/Use Alternative[amprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [aprepitant] use alternative: combo may incr. or decr. sunitinib levels (hepatic metab. altered) [barbiturates] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bexarotene] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bosentan] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [carbamazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [clarithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [conivaptan] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [darunavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [delavirdine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dexamethasone] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz/emtricitabine/tenofovir] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo w/ efavirenz may decr. sunitinib levels, efficacy (hepatic metab. induced) [fluvoxamine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fosamprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [grapefruit] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [griseofulvins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [imatinib] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [indinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [itraconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [ketoconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [lopinavir/ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nefazodone] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nelfinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nevirapine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [oxcarbazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [phenytoins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [posaconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [rifabutin] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifampins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifapentine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [saquinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [st. 's wort] avoid concurrent use: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [telithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [tipranavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [voriconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Monitor/Modify Tx[growth hormone] caution advised: combo may decr. sunitinib levels, efficacy (hepatic metab. possibly induced) [lapatinib] caution advised, consider lower sunitinib doses: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Caution Advised[amiodarone] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dasatinib] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fluconazole] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [octreotide] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. possibly inhibited) [ranolazine] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Adverse ReactionsSerious ReactionsCHFMIHTN, severethromboembolismhemorrhage, majorneutropeniathrombocytopeniaGI perforation (rare)pancreatitis (rare)hypothyroidismadrenal insufficiencyadrenal toxicity (animal studies)seizures (rare)Common Reactionsneutropeniaelevated ALT, AST, bilirubinlymphopeniathrombocytopeniadiarrheaabdominal painanorexianausea/vomitingskin discolorationmucositis/stomatitiselevated amylase/lipaseelevated alk phosastheniataste changesconstipationbleedingfeverHTNrashhand-foot syndromemyalgia/arthralgiahypokalemiaheadacheback paindecreased LVEFdyspneahypernatremiaanemiaelevated CrcoughSafety MonitoringPregnancy: DLactation: Possibly UnsafeMonitoring Parameters: CBC, Plt, serum chemistries (incl. PO4) prior to each cycle; LVEF at baseline, then if cardiac risk factors cont. periodically; BPPharmacologyMetabolism: liver; CYP450: 3A4 substrate; Info: active metaboliteExcretion: feces 61%, urine 16%; Half-life: 40-60h (parent), 80-110h (metabolite)Class: Other Oncologics Mechanism Of Action: inhibits phosphorylation of multiple tyrosine kinases, resulting in anti-cancer and anti-angiogenesis effects Manufacturer/PricingManufacturer: Pfizer Inc.DEA/FDA: Rx

Patient Education

Generic Name:

sunitinib

Pronounced:

soo NIT in ib

What is the most important information I should know about sunitinib?

Do not use this medication if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.

Before using sunitinib, tell your doctor if you have high blood pressure, a thyroid disorder, a heart rhythm disorder, or if you have ever had a heart attack, congestive heart failure, a stroke, or blood clots.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Stop using sunitinib and call your doctor at once if you have chest pain, shortness or breath, sudden numbness or weakness, sudden headache or vision problems, or any unusual bruising or bleeding.

What is sunitinib?

Sunitinib is a cancer medicine that helps the body slow down the growth and reproduction of certain cells, including tumor cells.

Sunitinib is used to treat certain types of advanced or progressive tumors of the digestive system or the kidneys.

Sunitinib may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before using sunitinib?

Before using sunitinib, tell your doctor if you have:

high blood pressure;

a thyroid disorder;

a heart rhythm disorder;

a personal or family history of "Long QT syndrome";

a history of heart attack or congestive heart failure; or

a history of stroke, blood clots, coronary artery disease, bypass graft surgery, or transient ischemic attack (TIA).

If you have any of these conditions, you may not be able to use sunitinib or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category D: This medication can cause harm to an unborn baby. Do not use sunitinib if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.

It is not known if sunitinib passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take sunitinib?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Sunitinib is usually taken once every day for 4 weeks, followed by 2 weeks off the drug. Your doctor will determine how many complete treatment cycles you need based on your condition.

Sunitinib may be taken with or without food.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Store sunitinib at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a sunitinib overdose may include muscle weakness, shaking or chills, and stomach pain.

What should I avoid while taking sunitinib?

Avoid taking an herbal supplement containing St. 's wort at the same time you are taking sunitinib.

What are the possible side effects of sunitinib?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using sunitinib and call your doctor at once if you have any of these serious side effects:

chest pain, general ill feeling;

uneven heart rate;

feeling short of breath, even with mild exertion;

swelling of your ankles or feet;

weakness, tired feeling, nausea, loss of appetite, weight loss;

sudden numbness or weakness, especially on one side of the body;

sudden headache, confusion, problems with vision, speech, or balance;

redness, tenderness, sunburn-like peeling of the palms of your hands or the soles of your feet;

bloody, or black, tarry stools;

coughing up blood or vomit that looks like coffee grounds;

easy bruising or bleeding, unusual weakness; or

white patches or sores inside your mouth or on your lips.

Keep using sunitinib and talk with your doctor if you have any of these less serious side effects:

unusual or unpleasant taste in the mouth;

nausea, vomiting, stomach pain or upset;

diarrhea or constipation;

skin rash, hair loss, changes in skin or hair color; or

headache, joint or muscle pain.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect sunitinib?

Before taking sunitinib, tell your doctor if you are using any of the following drugs:

ketoconazole (Nizoral), itraconazole (Sporanox), voriconazole (VFend);

dexamethasone (Decadron, Dexacort);

nefazodone (Serzone);

seizure medicines such as carbamazepine (Carbatrol, Tegretol), phenytoin (Dilantin), or phenobarbital (Luminal, Solfoton);

rifampin (Rifadin, Rimactane), rifabutin (Mycobutin), rifapentin (Priftin);

clarithromycin (Biaxin), telithromycin (Ketek); or

HIV medicines such as atazanavir (Reyataz), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Invirase, Fortovase).

If you are using any of these drugs, you may not be able to take sunitinib, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect sunitinib. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist has information about sunitinib written for health professionals that you may read.

What does my medication look like?

Sunitinib is available with a prescription under the brand name Sutent. Other brand or generic forms may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

Sutent 12.5 mg--orange capsule

Sutent 25 mg--caramel and orange capsule

Sutent 50 mg--caramel capsule

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Pill Pictures

This information is currently unavailable or not applicable for this drug.

Substantial effort has been made to ensure that the information provided by Epocrates is accurate and up-to-date, but this information is not intended to cover all possible uses, precautions, or other considerations relating to the therapies covered. Epocrates does not advocate or endorse the use of any drug or other therapy and does not diagnose patients. Healthcare professionals should use their professional judgment in using this information, and this information should not be considered a substitute for the care and professional judgment provided by a licensed healthcare practitioner. This information if provided on an "as is" basis, and Epocrates and its affiliates, agents and licensors assume no responsibility for any aspect of healthcare administered with the aid of this information or any other use of the information.

Receipt of this message does not mean that you have been opted into Epocrates email. If you wish to ensure that you do not receive any further emails of this type from Epocrates, please email unsubscribeonline (DOT) epocrates.com.

No virus found in this incoming message.Checked by AVG Free Edition. Version: 7.5.488 / Virus Database: 269.14.13/1075 - Release Date: 10/17/2007 9:38 AM

October 18, 2007

Art, I'll put you in my reikibox. So anyway you get help from it. And by reading all the messages, we are here with a few reiki-people that can help.

Joyce, maybe an idea also to put a healing-list for members here to support them who are in need. It has nothing to do with herbs but can give more courage for the persons in need to know they are also helped in another way.

e :-)

From: art@...Date: Wed, 17 Oct 2007 21:46:32 -0700Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

I need to lose 133 pounds also fast.

My doctor said my symtoms are from the vitamins and stuff.

My sister was suppose to pick me up tonight to go to another Reiki healing but she never showed up/

http://www.roswellpark.org/Site/Home/MMNR/Press/The_Best_Doctors_In_America_at_RPCI

This is the cancer hospital I go to.

----- Original Message -----

From: Joyce Hudson

Sent: Wednesday, October 17, 2007 8:42 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

Art, remember the kidney cancer is almost gone. You still need to find a new doctor though. Your symptoms are horrible, but they won't last forever. Always find the positive in everything. I will be signing off the groups soon for the night. I have some files to work on. I hope you get a good night sleep. I will say prayers. Remember to open you heart chakra to receive healing from Reiki practitioners. Imagine the area where your heart is, as a big flower like a Lotus. Imagine the flower petals opening so that they are flat. Then remember to close the petals so that they are standing straight up, before you go to sleep. I will send prayers and Light to you. Blessings, Joy

----- Original Message -----

From: Art3

Sent: Wednesday, October 17, 2007 11:24 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

I take it 3 weeks off 1 week and mine is 50MG.

I have abdominal painanorexianausea/vomitingskin discolorationtaste changesconstipationRash

back pain

swelling of your ankles or feet;

weakness, tired feeling, nausea, loss of appetite, weight loss;

sudden numbness or weakness, especially on one side of the body;

redness, tenderness, sunburn-like peeling of the palms of your hands or the soles of your feet;

bloody, or black, tarry stools;

white patches or sores inside your mouth or on your lips.

unusual or unpleasant taste in the mouth;

nausea,stomach pain or upset;

constipation;

skin rash, hair loss, changes in skin or hair color; or

headache, joint or muscle pain.

----- Original Message -----

From:

..

for art

----- Original Message ----- From: Nancie Barnett

deifspiritmsn

Sent: Wednesday, October 17, 2007 6:48 PM

Subject: Clinical Information from Epocrates Online (Premium Version)

The clinical content below is part of the Epocrates® Online database.For a free subscription to Epocrates Online, visit us at http://www.epocrates.com/products/online/index.html.

Message From Senderfor art

Drug

Sutentsunitinib

Adult Dosing

chemotherapy[uses, dosing may vary]Info: for all uses, refer to institution protocols and pkg insert prior to prescribinggastrointestinal stromal tumor, refractory[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal cell CA, advanced[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal dosing[not defined]hepatic dosing[not defined]Peds Dosing

This information is currently unavailable or not applicable for this drug.Contraindications/Cautionshypersens. to drug/class/compon.see Drug Interactionspregnancy not recommendedbreastfeeding not recommendedCHFcaution if thromboembolic event w/in 1ycaution if ischemic cardiac event w/in 1ycaution if HTNcaution if recent surgery/traumacaution if infectionDrug InteractionsContraindicated[atazanavir] contraindicated: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Avoid/Use Alternative[amprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [aprepitant] use alternative: combo may incr. or decr. sunitinib levels (hepatic metab. altered) [barbiturates] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bexarotene] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bosentan] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [carbamazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [clarithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [conivaptan] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [darunavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [delavirdine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dexamethasone] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz/emtricitabine/tenofovir] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo w/ efavirenz may decr. sunitinib levels, efficacy (hepatic metab. induced) [fluvoxamine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fosamprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [grapefruit] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [griseofulvins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [imatinib] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [indinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [itraconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [ketoconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [lopinavir/ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nefazodone] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nelfinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nevirapine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [oxcarbazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [phenytoins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [posaconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [rifabutin] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifampins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifapentine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [saquinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [st. 's wort] avoid concurrent use: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [telithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [tipranavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [voriconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Monitor/Modify Tx[growth hormone] caution advised: combo may decr. sunitinib levels, efficacy (hepatic metab. possibly induced) [lapatinib] caution advised, consider lower sunitinib doses: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Caution Advised[amiodarone] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dasatinib] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fluconazole] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [octreotide] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. possibly inhibited) [ranolazine] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Adverse ReactionsSerious ReactionsCHFMIHTN, severethromboembolismhemorrhage, majorneutropeniathrombocytopeniaGI perforation (rare)pancreatitis (rare)hypothyroidismadrenal insufficiencyadrenal toxicity (animal studies)seizures (rare)Common Reactionsneutropeniaelevated ALT, AST, bilirubinlymphopeniathrombocytopeniadiarrheaabdominal painanorexianausea/vomitingskin discolorationmucositis/stomatitiselevated amylase/lipaseelevated alk phosastheniataste changesconstipationbleedingfeverHTNrashhand-foot syndromemyalgia/arthralgiahypokalemiaheadacheback paindecreased LVEFdyspneahypernatremiaanemiaelevated CrcoughSafety MonitoringPregnancy: DLactation: Possibly UnsafeMonitoring Parameters: CBC, Plt, serum chemistries (incl. PO4) prior to each cycle; LVEF at baseline, then if cardiac risk factors cont. periodically; BPPharmacologyMetabolism: liver; CYP450: 3A4 substrate; Info: active metaboliteExcretion: feces 61%, urine 16%; Half-life: 40-60h (parent), 80-110h (metabolite)Class: Other Oncologics Mechanism Of Action: inhibits phosphorylation of multiple tyrosine kinases, resulting in anti-cancer and anti-angiogenesis effects Manufacturer/PricingManufacturer: Pfizer Inc.DEA/FDA: Rx

Patient Education

Generic Name:

sunitinib

Pronounced:

soo NIT in ib

What is the most important information I should know about sunitinib?

Do not use this medication if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.

Before using sunitinib, tell your doctor if you have high blood pressure, a thyroid disorder, a heart rhythm disorder, or if you have ever had a heart attack, congestive heart failure, a stroke, or blood clots.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Stop using sunitinib and call your doctor at once if you have chest pain, shortness or breath, sudden numbness or weakness, sudden headache or vision problems, or any unusual bruising or bleeding.

What is sunitinib?

Sunitinib is a cancer medicine that helps the body slow down the growth and reproduction of certain cells, including tumor cells.

Sunitinib is used to treat certain types of advanced or progressive tumors of the digestive system or the kidneys.

Sunitinib may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before using sunitinib?

Before using sunitinib, tell your doctor if you have:

high blood pressure;

a thyroid disorder;

a heart rhythm disorder;

a personal or family history of "Long QT syndrome";

a history of heart attack or congestive heart failure; or

a history of stroke, blood clots, coronary artery disease, bypass graft surgery, or transient ischemic attack (TIA).

If you have any of these conditions, you may not be able to use sunitinib or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category D: This medication can cause harm to an unborn baby. Do not use sunitinib if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.

It is not known if sunitinib passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take sunitinib?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Sunitinib is usually taken once every day for 4 weeks, followed by 2 weeks off the drug. Your doctor will determine how many complete treatment cycles you need based on your condition.

Sunitinib may be taken with or without food.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Store sunitinib at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a sunitinib overdose may include muscle weakness, shaking or chills, and stomach pain.

What should I avoid while taking sunitinib?

Avoid taking an herbal supplement containing St. 's wort at the same time you are taking sunitinib.

What are the possible side effects of sunitinib?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using sunitinib and call your doctor at once if you have any of these serious side effects:

chest pain, general ill feeling;

uneven heart rate;

feeling short of breath, even with mild exertion;

swelling of your ankles or feet;

weakness, tired feeling, nausea, loss of appetite, weight loss;

sudden numbness or weakness, especially on one side of the body;

sudden headache, confusion, problems with vision, speech, or balance;

redness, tenderness, sunburn-like peeling of the palms of your hands or the soles of your feet;

bloody, or black, tarry stools;

coughing up blood or vomit that looks like coffee grounds;

easy bruising or bleeding, unusual weakness; or

white patches or sores inside your mouth or on your lips.

Keep using sunitinib and talk with your doctor if you have any of these less serious side effects:

unusual or unpleasant taste in the mouth;

nausea, vomiting, stomach pain or upset;

diarrhea or constipation;

skin rash, hair loss, changes in skin or hair color; or

headache, joint or muscle pain.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect sunitinib?

Before taking sunitinib, tell your doctor if you are using any of the following drugs:

ketoconazole (Nizoral), itraconazole (Sporanox), voriconazole (VFend);

dexamethasone (Decadron, Dexacort);

nefazodone (Serzone);

seizure medicines such as carbamazepine (Carbatrol, Tegretol), phenytoin (Dilantin), or phenobarbital (Luminal, Solfoton);

rifampin (Rifadin, Rimactane), rifabutin (Mycobutin), rifapentin (Priftin);

clarithromycin (Biaxin), telithromycin (Ketek); or

HIV medicines such as atazanavir (Reyataz), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Invirase, Fortovase).

If you are using any of these drugs, you may not be able to take sunitinib, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect sunitinib. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist has information about sunitinib written for health professionals that you may read.

What does my medication look like?

Sunitinib is available with a prescription under the brand name Sutent. Other brand or generic forms may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

Sutent 12.5 mg--orange capsule

Sutent 25 mg--caramel and orange capsule

Sutent 50 mg--caramel capsule

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Pill Pictures

This information is currently unavailable or not applicable for this drug.

Substantial effort has been made to ensure that the information provided by Epocrates is accurate and up-to-date, but this information is not intended to cover all possible uses, precautions, or other considerations relating to the therapies covered. Epocrates does not advocate or endorse the use of any drug or other therapy and does not diagnose patients. Healthcare professionals should use their professional judgment in using this information, and this information should not be considered a substitute for the care and professional judgment provided by a licensed healthcare practitioner. This information if provided on an "as is" basis, and Epocrates and its affiliates, agents and licensors assume no responsibility for any aspect of healthcare administered with the aid of this information or any other use of the information.

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October 18, 2007

Great idea e! I will create a file called "Prayer List". If anyone knows of a person who would like to be added to the list, just go to the file and add that person's name with the date you are adding the name. Thank you e. Blessings, Joy

----- Original Message -----

From: e Bonte

natural_remedies

Sent: Thursday, October 18, 2007 1:57 AM

Subject: RE: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

Art, I'll put you in my reikibox. So anyway you get help from it. And by reading all the messages, we are here with a few reiki-people that can help. Joyce, maybe an idea also to put a healing-list for members here to support them who are in need. It has nothing to do with herbs but can give more courage for the persons in need to know they are also helped in another way. e :-)

From: art@...Date: Wed, 17 Oct 2007 21:46:32 -0700Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

I need to lose 133 pounds also fast.

My doctor said my symtoms are from the vitamins and stuff.

My sister was suppose to pick me up tonight to go to another Reiki healing but she never showed up/

http://www.roswellpark.org/Site/Home/MMNR/Press/The_Best_Doctors_In_America_at_RPCI

This is the cancer hospital I go to.

----- Original Message -----

From: Joyce Hudson

Sent: Wednesday, October 17, 2007 8:42 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

Art, remember the kidney cancer is almost gone. You still need to find a new doctor though. Your symptoms are horrible, but they won't last forever. Always find the positive in everything. I will be signing off the groups soon for the night. I have some files to work on. I hope you get a good night sleep. I will say prayers. Remember to open you heart chakra to receive healing from Reiki practitioners. Imagine the area where your heart is, as a big flower like a Lotus. Imagine the flower petals opening so that they are flat. Then remember to close the petals so that they are standing straight up, before you go to sleep. I will send prayers and Light to you. Blessings, Joy

----- Original Message -----

From: Art3

Sent: Wednesday, October 17, 2007 11:24 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

I take it 3 weeks off 1 week and mine is 50MG.

I have abdominal painanorexianausea/vomitingskin discolorationtaste changesconstipationRash

back pain

swelling of your ankles or feet;

weakness, tired feeling, nausea, loss of appetite, weight loss;

sudden numbness or weakness, especially on one side of the body;

redness, tenderness, sunburn-like peeling of the palms of your hands or the soles of your feet;

bloody, or black, tarry stools;

white patches or sores inside your mouth or on your lips.

unusual or unpleasant taste in the mouth;

nausea,stomach pain or upset;

constipation;

skin rash, hair loss, changes in skin or hair color; or

headache, joint or muscle pain.

----- Original Message -----

From:

..

for art

----- Original Message ----- From: Nancie Barnett

deifspiritmsn

Sent: Wednesday, October 17, 2007 6:48 PM

Subject: Clinical Information from Epocrates Online (Premium Version)

The clinical content below is part of the Epocrates® Online database.For a free subscription to Epocrates Online, visit us at http://www.epocrates.com/products/online/index.html.

Message From Senderfor art

Drug

Sutentsunitinib

Adult Dosing

chemotherapy[uses, dosing may vary]Info: for all uses, refer to institution protocols and pkg insert prior to prescribinggastrointestinal stromal tumor, refractory[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal cell CA, advanced[50 mg PO qd x4wk]Info: repeat cycle of 4wk on and 2wk off therapy; adjust dose in 12.5 mg increments based on tolerability and safety; see Drug Interactions for adjustments based on concomitant tx w/ CYP3A4 inducers or potent inhibitorsrenal dosing[not defined]hepatic dosing[not defined]Peds Dosing

This information is currently unavailable or not applicable for this drug.Contraindications/Cautionshypersens. to drug/class/compon.see Drug Interactionspregnancy not recommendedbreastfeeding not recommendedCHFcaution if thromboembolic event w/in 1ycaution if ischemic cardiac event w/in 1ycaution if HTNcaution if recent surgery/traumacaution if infectionDrug InteractionsContraindicated[atazanavir] contraindicated: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Avoid/Use Alternative[amprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [aprepitant] use alternative: combo may incr. or decr. sunitinib levels (hepatic metab. altered) [barbiturates] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bexarotene] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [bosentan] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [carbamazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [clarithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [conivaptan] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [darunavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [delavirdine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dexamethasone] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [efavirenz/emtricitabine/tenofovir] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo w/ efavirenz may decr. sunitinib levels, efficacy (hepatic metab. induced) [fluvoxamine] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fosamprenavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [grapefruit] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [griseofulvins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [imatinib] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [indinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [itraconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [ketoconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [lopinavir/ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nefazodone] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nelfinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [nevirapine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [oxcarbazepine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [phenytoins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [posaconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [rifabutin] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifampins] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [rifapentine] use alternative or consider incr. sunitinib dose to max 87.5 mg/day and monitor toxicity: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [ritonavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [saquinavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [st. 's wort] avoid concurrent use: combo may decr. sunitinib levels, efficacy (hepatic metab. induced) [telithromycin] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [tipranavir] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [voriconazole] use alternative or consider decr. sunitinib dose to minimum 37.5 mg/day: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Monitor/Modify Tx[growth hormone] caution advised: combo may decr. sunitinib levels, efficacy (hepatic metab. possibly induced) [lapatinib] caution advised, consider lower sunitinib doses: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Caution Advised[amiodarone] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [dasatinib] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [fluconazole] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) [octreotide] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. possibly inhibited) [ranolazine] caution advised: combo may incr. sunitinib levels, risk of toxicity (hepatic metab. inhibited) Adverse ReactionsSerious ReactionsCHFMIHTN, severethromboembolismhemorrhage, majorneutropeniathrombocytopeniaGI perforation (rare)pancreatitis (rare)hypothyroidismadrenal insufficiencyadrenal toxicity (animal studies)seizures (rare)Common Reactionsneutropeniaelevated ALT, AST, bilirubinlymphopeniathrombocytopeniadiarrheaabdominal painanorexianausea/vomitingskin discolorationmucositis/stomatitiselevated amylase/lipaseelevated alk phosastheniataste changesconstipationbleedingfeverHTNrashhand-foot syndromemyalgia/arthralgiahypokalemiaheadacheback paindecreased LVEFdyspneahypernatremiaanemiaelevated CrcoughSafety MonitoringPregnancy: DLactation: Possibly UnsafeMonitoring Parameters: CBC, Plt, serum chemistries (incl. PO4) prior to each cycle; LVEF at baseline, then if cardiac risk factors cont. periodically; BPPharmacologyMetabolism: liver; CYP450: 3A4 substrate; Info: active metaboliteExcretion: feces 61%, urine 16%; Half-life: 40-60h (parent), 80-110h (metabolite)Class: Other Oncologics Mechanism Of Action: inhibits phosphorylation of multiple tyrosine kinases, resulting in anti-cancer and anti-angiogenesis effects Manufacturer/PricingManufacturer: Pfizer Inc.DEA/FDA: Rx

Patient Education

Generic Name:

sunitinib

Pronounced:

soo NIT in ib

What is the most important information I should know about sunitinib?

Do not use this medication if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.

Before using sunitinib, tell your doctor if you have high blood pressure, a thyroid disorder, a heart rhythm disorder, or if you have ever had a heart attack, congestive heart failure, a stroke, or blood clots.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Stop using sunitinib and call your doctor at once if you have chest pain, shortness or breath, sudden numbness or weakness, sudden headache or vision problems, or any unusual bruising or bleeding.

What is sunitinib?

Sunitinib is a cancer medicine that helps the body slow down the growth and reproduction of certain cells, including tumor cells.

Sunitinib is used to treat certain types of advanced or progressive tumors of the digestive system or the kidneys.

Sunitinib may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before using sunitinib?

Before using sunitinib, tell your doctor if you have:

high blood pressure;

a thyroid disorder;

a heart rhythm disorder;

a personal or family history of "Long QT syndrome";

a history of heart attack or congestive heart failure; or

a history of stroke, blood clots, coronary artery disease, bypass graft surgery, or transient ischemic attack (TIA).

If you have any of these conditions, you may not be able to use sunitinib or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category D: This medication can cause harm to an unborn baby. Do not use sunitinib if you are pregnant. Tell your doctor if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.

It is not known if sunitinib passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take sunitinib?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Sunitinib is usually taken once every day for 4 weeks, followed by 2 weeks off the drug. Your doctor will determine how many complete treatment cycles you need based on your condition.

Sunitinib may be taken with or without food.

To be sure this medication is helping your condition and is not causing certain side effects, your blood and blood pressure may need to be tested at the beginning of each 4-week treatment cycle. Your heart function may also need to be tested with an electrocardiogram (ECG or EKG) on a regular basis. It is important that you not miss any scheduled visits to your doctor.

Store sunitinib at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a sunitinib overdose may include muscle weakness, shaking or chills, and stomach pain.

What should I avoid while taking sunitinib?

Avoid taking an herbal supplement containing St. 's wort at the same time you are taking sunitinib.

What are the possible side effects of sunitinib?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using sunitinib and call your doctor at once if you have any of these serious side effects:

chest pain, general ill feeling;

uneven heart rate;

feeling short of breath, even with mild exertion;

swelling of your ankles or feet;

weakness, tired feeling, nausea, loss of appetite, weight loss;

sudden numbness or weakness, especially on one side of the body;

sudden headache, confusion, problems with vision, speech, or balance;

redness, tenderness, sunburn-like peeling of the palms of your hands or the soles of your feet;

bloody, or black, tarry stools;

coughing up blood or vomit that looks like coffee grounds;

easy bruising or bleeding, unusual weakness; or

white patches or sores inside your mouth or on your lips.

Keep using sunitinib and talk with your doctor if you have any of these less serious side effects:

unusual or unpleasant taste in the mouth;

nausea, vomiting, stomach pain or upset;

diarrhea or constipation;

skin rash, hair loss, changes in skin or hair color; or

headache, joint or muscle pain.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect sunitinib?

Before taking sunitinib, tell your doctor if you are using any of the following drugs:

ketoconazole (Nizoral), itraconazole (Sporanox), voriconazole (VFend);

dexamethasone (Decadron, Dexacort);

nefazodone (Serzone);

seizure medicines such as carbamazepine (Carbatrol, Tegretol), phenytoin (Dilantin), or phenobarbital (Luminal, Solfoton);

rifampin (Rifadin, Rimactane), rifabutin (Mycobutin), rifapentin (Priftin);

clarithromycin (Biaxin), telithromycin (Ketek); or

HIV medicines such as atazanavir (Reyataz), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Invirase, Fortovase).

If you are using any of these drugs, you may not be able to take sunitinib, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect sunitinib. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist has information about sunitinib written for health professionals that you may read.

What does my medication look like?

Sunitinib is available with a prescription under the brand name Sutent. Other brand or generic forms may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

Sutent 12.5 mg--orange capsule

Sutent 25 mg--caramel and orange capsule

Sutent 50 mg--caramel capsule

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Pill PicturesThis information is currently unavailable or not applicable for this drug.

Substantial effort has been made to ensure that the information provided by Epocrates is accurate and up-to-date, but this information is not intended to cover all possible uses, precautions, or other considerations relating to the therapies covered. Epocrates does not advocate or endorse the use of any drug or other therapy and does not diagnose patients. Healthcare professionals should use their professional judgment in using this information, and this information should not be considered a substitute for the care and professional judgment provided by a licensed healthcare practitioner. This information if provided on an "as is" basis, and Epocrates and its affiliates, agents and licensors assume no responsibility for any aspect of healthcare administered with the aid of this information or any other use of the information.

Receipt of this message does not mean that you have been opted into Epocrates email. If you wish to ensure that you do not receive any further emails of this type from Epocrates, please email unsubscribeonline (DOT) epocrates.com.

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October 18, 2007

DEWEY combat medic Fleet Marine Force-----Viet NamJoyce Hudson <bjoyful@...> wrote: Nancie, I am thrilled that you are a nurse practioner! You will have so much to share with us. And please do share! And if you know something that you have seen the opposite of what we post, please feel free to speak up. I wonder if we have any other medical people here? Blessings

in Love and Light. Joy __________________________________________________

October 18, 2007

Dewey, I am excited that you are here. You may open our eyes even more! Please share what you know and if you disagree with anything posted, please speak up.

Blessings only in Love and Light. Joy

----- Original Message -----

From: FT Dewey

Sent: Thursday, October 18, 2007 2:50 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

DEWEY combat medic Fleet Marine Force-----Viet NamJoyce Hudson <bjoyful@...> wrote:

Nancie, I am thrilled that you are a nurse practioner! You will have so much to share with us. And please do share! And if you know something that you have seen the opposite of what we post, please feel free to speak up.

I wonder if we have any other medical people here?

Blessings in Love and Light. Joy

__________________________________________________

October 21, 2007

ART,

I do not know where to start.

YOU are being poisoned

all these new pills have so many [[[ side affects]]]

I would for sure try to slip them into the doctors

Coffey when he isn't looking!!

STOMPINGELK

--- Art3 <art@...> wrote:

> I take it 3 weeks off 1 week and mine is 50MG.

> I have abdominal pain

> anorexia

> nausea/vomiting

> skin discoloration

> taste changes

> constipation

> Rash

> back pain

>

> a.. swelling of your ankles or feet;

> a.. weakness, tired feeling, nausea, loss of

> appetite, weight loss;

> a.. sudden numbness or weakness, especially on one

> side of the body;

> a..

> a.. redness, tenderness, sunburn-like peeling of the

> palms of your hands or the soles of your feet;

> a.. bloody, or black, tarry stools;

> a.. white patches or sores inside your mouth or on

> your lips.

> a.. unusual or unpleasant taste in the mouth;

> a.. nausea,stomach pain or upset;

> a.. constipation;

> a.. skin rash, hair loss, changes in skin or hair

> color; or

> a.. headache, joint or muscle pain.

>

> ----- Original Message -----

> From:

> .

>

> for art

> ----- Original Message -----

> From: Nancie Barnett

> deifspirit@...

> Sent: Wednesday, October 17, 2007 6:48 PM

> Subject: Clinical Information from Epocrates

> Online (Premium Version)

>

> The clinical content below is part of the

> Epocrates® Online database.

> For a free subscription to Epocrates

> Online, visit us at

> http://www.epocrates.com/products/online/index.html.

>

> Message From Sender

> for art

>

> Drug

>

> Sutent

> sunitinib

>

> Adult Dosing

>

> chemotherapy

> [uses, dosing may vary]

> Info: for all uses, refer to

> institution protocols and pkg insert prior to

> prescribing

>

> gastrointestinal stromal tumor,

> refractory

> [50 mg PO qd x4wk]

> Info: repeat cycle of 4wk on and 2wk

> off therapy; adjust dose in 12.5 mg increments based

> on tolerability and safety; see Drug Interactions

> for adjustments based on concomitant tx w/ CYP3A4

> inducers or potent inhibitors

>

> renal cell CA, advanced

> [50 mg PO qd x4wk]

> Info: repeat cycle of 4wk on and 2wk

> off therapy; adjust dose in 12.5 mg increments based

> on tolerability and safety; see Drug Interactions

> for adjustments based on concomitant tx w/ CYP3A4

> inducers or potent inhibitors

>

> renal dosing

> [not defined]

>

> hepatic dosing

> [not defined]

>

> Peds Dosing

>

> This information is currently unavailable

> or not applicable for this drug.

>

> Contraindications/Cautions

>

> hypersens. to drug/class/compon.

> see Drug Interactions

> pregnancy not recommended

> breastfeeding not recommended

> CHF

> caution if thromboembolic event w/in 1y

> caution if ischemic cardiac event w/in 1y

> caution if HTN

> caution if recent surgery/trauma

> caution if infection

>

> Drug Interactions

>

> Contraindicated

> [atazanavir]

> contraindicated: combo may incr. sunitinib

> levels, risk of toxicity (hepatic metab. inhibited)

>

> Avoid/Use Alternative

> [amprenavir]

> use alternative or consider decr.

> sunitinib dose to minimum 37.5 mg/day: combo may

> incr. sunitinib levels, risk of toxicity (hepatic

> metab. inhibited)

>

> [aprepitant]

> use alternative: combo may incr. or decr.

> sunitinib levels (hepatic metab. altered)

>

> [barbiturates]

> use alternative or consider incr.

> sunitinib dose to max 87.5 mg/day and monitor

> toxicity: combo may decr. sunitinib levels, efficacy

> (hepatic metab. induced)

>

> [bexarotene]

> use alternative or consider incr.

> sunitinib dose to max 87.5 mg/day and monitor

> toxicity: combo may decr. sunitinib levels, efficacy

> (hepatic metab. induced)

>

> [bosentan]

> use alternative or consider incr.

> sunitinib dose to max 87.5 mg/day and monitor

> toxicity: combo may decr. sunitinib levels, efficacy

> (hepatic metab. induced)

>

> [carbamazepine]

> use alternative or consider incr.

> sunitinib dose to max 87.5 mg/day and monitor

> toxicity: combo may decr. sunitinib levels, efficacy

> (hepatic metab. induced)

>

> [clarithromycin]

> use alternative or consider decr.

> sunitinib dose to minimum 37.5 mg/day: combo may

> incr. sunitinib levels, risk of toxicity (hepatic

> metab. inhibited)

>

> [conivaptan]

> use alternative or consider decr.

> sunitinib dose to minimum 37.5 mg/day: combo may

> incr. sunitinib levels, risk of toxicity (hepatic

> metab. inhibited)

>

> [darunavir]

> use alternative or consider decr.

> sunitinib dose to minimum 37.5 mg/day: combo may

> incr. sunitinib levels, risk of toxicity (hepatic

> metab. inhibited)

>

> [delavirdine]

> use alternative or consider decr.

> sunitinib dose to minimum 37.5 mg/day: combo may

> incr. sunitinib levels, risk of toxicity (hepatic

> metab.

=== message truncated ===

Spiritual freedom is my birthright.

I am a free thinker. I am able to rise above mental

prejudices and stereotypes of others.

I am a free thinker. Nobody and nothing can manipulate

me or deceive me.

I am a free thinker. I freely choose truth and love.

Today, I embrace a greater degree of spiritual

freedom.

__________________________________________________

October 21, 2007

I stopped taking everything and my whole legs hurts now instead of my ankle and it's hard to walk. How long will it take to get the poison out of my system?

----- Original Message -----

From: Marty Cline

Sent: Sunday, October 21, 2007 10:48 AM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

ART,I do not know where to start.YOU are being poisonedall these new pills have so many [[[ side affects]]]I would for sure try to slip them into the doctorsCoffey when he isn't looking!!STOMPINGELK--- Art3 <artfroggernet> wrote:> I take it 3 weeks off 1 week and mine is 50MG.> I have abdominal pain> anorexia> nausea/vomiting> skin discoloration> taste changes> constipation> Rash> back pain> > a.. swelling of your ankles or feet; > a.. weakness, tired feeling, nausea, loss of> appetite, weight loss; > a.. sudden numbness or weakness, especially on one> side of the body;> a.. > a.. redness, tenderness, sunburn-like peeling of the> palms of your hands or the soles of your feet; > a.. bloody, or black, tarry stools; > a.. white patches or sores inside your mouth or on> your lips. > a.. unusual or unpleasant taste in the mouth; > a.. nausea,stomach pain or upset; > a.. constipation; > a.. skin rash, hair loss, changes in skin or hair> color; or > a.. headache, joint or muscle pain. > > > > > ----- Original Message ----- > From:> .> > > for art> ----- Original Message ----- > From: Nancie Barnett > deifspiritmsn > Sent: Wednesday, October 17, 2007 6:48 PM> Subject: Clinical Information from Epocrates> Online (Premium Version)> > > > The clinical content below is part of the> Epocrates® Online database.> For a free subscription to Epocrates> Online, visit us at> http://www.epocrates.com/products/online/index.html.> > > > > Message From Sender> for art > > > > > > > > > Drug> > > > Sutent> sunitinib > > > > > Adult Dosing> > > > chemotherapy> [uses, dosing may vary]> Info: for all uses, refer to> institution protocols and pkg insert prior to> prescribing> > gastrointestinal stromal tumor,> refractory> [50 mg PO qd x4wk]> Info: repeat cycle of 4wk on and 2wk> off therapy; adjust dose in 12.5 mg increments based> on tolerability and safety; see Drug Interactions> for adjustments based on concomitant tx w/ CYP3A4> inducers or potent inhibitors> > renal cell CA, advanced> [50 mg PO qd x4wk]> Info: repeat cycle of 4wk on and 2wk> off therapy; adjust dose in 12.5 mg increments based> on tolerability and safety; see Drug Interactions> for adjustments based on concomitant tx w/ CYP3A4> inducers or potent inhibitors> > renal dosing> [not defined]> > hepatic dosing> [not defined]> > > > Peds Dosing> > > > This information is currently unavailable> or not applicable for this drug.> > > Contraindications/Cautions> > > > hypersens. to drug/class/compon.> see Drug Interactions> pregnancy not recommended> breastfeeding not recommended> CHF> caution if thromboembolic event w/in 1y> caution if ischemic cardiac event w/in 1y> caution if HTN> caution if recent surgery/trauma> caution if infection> > Drug Interactions> > > > > Contraindicated> [atazanavir] > contraindicated: combo may incr. sunitinib> levels, risk of toxicity (hepatic metab. inhibited) > > > Avoid/Use Alternative> [amprenavir] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [aprepitant] > use alternative: combo may incr. or decr.> sunitinib levels (hepatic metab. altered) > > [barbiturates] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [bexarotene] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [bosentan] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [carbamazepine] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [clarithromycin] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [conivaptan] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [darunavir] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [delavirdine] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. === message truncated ===Spiritual freedom is my birthright. I am a free thinker. I am able to rise above mentalprejudices and stereotypes of others. I am a free thinker. Nobody and nothing can manipulateme or deceive me. I am a free thinker. I freely choose truth and love. Today, I embrace a greater degree of spiritualfreedom.__________________________________________________

October 21, 2007

How much water are you drinking, Art? Is your body retaining water or are you urinating good? Joy

----- Original Message -----

From: Art3

Sent: Sunday, October 21, 2007 2:27 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

I stopped taking everything and my whole legs hurts now instead of my ankle and it's hard to walk. How long will it take to get the poison out of my system?

----- Original Message -----

From: Marty Cline

Sent: Sunday, October 21, 2007 10:48 AM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

ART,I do not know where to start.YOU are being poisonedall these new pills have so many [[[ side affects]]]I would for sure try to slip them into the doctorsCoffey when he isn't looking!!STOMPINGELK--- Art3 <artfroggernet> wrote:> I take it 3 weeks off 1 week and mine is 50MG.> I have abdominal pain> anorexia> nausea/vomiting> skin discoloration> taste changes> constipation> Rash> back pain> > a.. swelling of your ankles or feet; > a.. weakness, tired feeling, nausea, loss of> appetite, weight loss; > a.. sudden numbness or weakness, especially on one> side of the body;> a.. > a.. redness, tenderness, sunburn-like peeling of the> palms of your hands or the soles of your feet; > a.. bloody, or black, tarry stools; > a.. white patches or sores inside your mouth or on> your lips. > a.. unusual or unpleasant taste in the mouth; > a.. nausea,stomach pain or upset; > a.. constipation; > a.. skin rash, hair loss, changes in skin or hair> color; or > a.. headache, joint or muscle pain. > > > > > ----- Original Message ----- > From:> .> > > for art> ----- Original Message ----- > From: Nancie Barnett > deifspiritmsn > Sent: Wednesday, October 17, 2007 6:48 PM> Subject: Clinical Information from Epocrates> Online (Premium Version)> > > > The clinical content below is part of the> Epocrates® Online database.> For a free subscription to Epocrates> Online, visit us at> http://www.epocrates.com/products/online/index.html.> > > > > Message From Sender> for art > > > > > > > > > Drug> > > > Sutent> sunitinib > > > > > Adult Dosing> > > > chemotherapy> [uses, dosing may vary]> Info: for all uses, refer to> institution protocols and pkg insert prior to> prescribing> > gastrointestinal stromal tumor,> refractory> [50 mg PO qd x4wk]> Info: repeat cycle of 4wk on and 2wk> off therapy; adjust dose in 12.5 mg increments based> on tolerability and safety; see Drug Interactions> for adjustments based on concomitant tx w/ CYP3A4> inducers or potent inhibitors> > renal cell CA, advanced> [50 mg PO qd x4wk]> Info: repeat cycle of 4wk on and 2wk> off therapy; adjust dose in 12.5 mg increments based> on tolerability and safety; see Drug Interactions> for adjustments based on concomitant tx w/ CYP3A4> inducers or potent inhibitors> > renal dosing> [not defined]> > hepatic dosing> [not defined]> > > > Peds Dosing> > > > This information is currently unavailable> or not applicable for this drug.> > > Contraindications/Cautions> > > > hypersens. to drug/class/compon.> see Drug Interactions> pregnancy not recommended> breastfeeding not recommended> CHF> caution if thromboembolic event w/in 1y> caution if ischemic cardiac event w/in 1y> caution if HTN> caution if recent surgery/trauma> caution if infection> > Drug Interactions> > > > > Contraindicated> [atazanavir] > contraindicated: combo may incr. sunitinib> levels, risk of toxicity (hepatic metab. inhibited) > > > Avoid/Use Alternative> [amprenavir] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [aprepitant] > use alternative: combo may incr. or decr.> sunitinib levels (hepatic metab. altered) > > [barbiturates] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [bexarotene] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [bosentan] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [carbamazepine] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [clarithromycin] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [conivaptan] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [darunavir] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [delavirdine] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. === message truncated ===Spiritual freedom is my birthright. I am a free thinker. I am able to rise above mentalprejudices and stereotypes of others. I am a free thinker. Nobody and nothing can manipulateme or deceive me. I am a free thinker. I freely choose truth and love. Today, I embrace a greater degree of spiritualfreedom.__________________________________________________

October 21, 2007

I'm drinking alot of water but it's starting to taste nasty and I retain alot of water and need 2 water pills but I stopped taking it and gained 5 pounds in 2 days.

Lat night I got sick of the tap water and drank cheery juice with aspertame in it and my throat started burning and now my leg hurts and cant walk again.

----- Original Message -----

From: Joyce Hudson

Sent: Sunday, October 21, 2007 12:21 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

How much water are you drinking, Art? Is your body retaining water or are you urinating good? Joy

----- Original Message -----

From: Art3

Sent: Sunday, October 21, 2007 2:27 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

I stopped taking everything and my whole legs hurts now instead of my ankle and it's hard to walk. How long will it take to get the poison out of my system?

----- Original Message -----

From: Marty Cline

Sent: Sunday, October 21, 2007 10:48 AM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

ART,I do not know where to start.YOU are being poisonedall these new pills have so many [[[ side affects]]]I would for sure try to slip them into the doctorsCoffey when he isn't looking!!STOMPINGELK--- Art3 <artfroggernet> wrote:> I take it 3 weeks off 1 week and mine is 50MG.> I have abdominal pain> anorexia> nausea/vomiting> skin discoloration> taste changes> constipation> Rash> back pain> > a.. swelling of your ankles or feet; > a.. weakness, tired feeling, nausea, loss of> appetite, weight loss; > a.. sudden numbness or weakness, especially on one> side of the body;> a.. > a.. redness, tenderness, sunburn-like peeling of the> palms of your hands or the soles of your feet; > a.. bloody, or black, tarry stools; > a.. white patches or sores inside your mouth or on> your lips. > a.. unusual or unpleasant taste in the mouth; > a.. nausea,stomach pain or upset; > a.. constipation; > a.. skin rash, hair loss, changes in skin or hair> color; or > a.. headache, joint or muscle pain. > > > > > ----- Original Message ----- > From:> .> > > for art> ----- Original Message ----- > From: Nancie Barnett > deifspiritmsn > Sent: Wednesday, October 17, 2007 6:48 PM> Subject: Clinical Information from Epocrates> Online (Premium Version)> > > > The clinical content below is part of the> Epocrates® Online database.> For a free subscription to Epocrates> Online, visit us at> http://www.epocrates.com/products/online/index.html.> > > > > Message From Sender> for art > > > > > > > > > Drug> > > > Sutent> sunitinib > > > > > Adult Dosing> > > > chemotherapy> [uses, dosing may vary]> Info: for all uses, refer to> institution protocols and pkg insert prior to> prescribing> > gastrointestinal stromal tumor,> refractory> [50 mg PO qd x4wk]> Info: repeat cycle of 4wk on and 2wk> off therapy; adjust dose in 12.5 mg increments based> on tolerability and safety; see Drug Interactions> for adjustments based on concomitant tx w/ CYP3A4> inducers or potent inhibitors> > renal cell CA, advanced> [50 mg PO qd x4wk]> Info: repeat cycle of 4wk on and 2wk> off therapy; adjust dose in 12.5 mg increments based> on tolerability and safety; see Drug Interactions> for adjustments based on concomitant tx w/ CYP3A4> inducers or potent inhibitors> > renal dosing> [not defined]> > hepatic dosing> [not defined]> > > > Peds Dosing> > > > This information is currently unavailable> or not applicable for this drug.> > > Contraindications/Cautions> > > > hypersens. to drug/class/compon.> see Drug Interactions> pregnancy not recommended> breastfeeding not recommended> CHF> caution if thromboembolic event w/in 1y> caution if ischemic cardiac event w/in 1y> caution if HTN> caution if recent surgery/trauma> caution if infection> > Drug Interactions> > > > > Contraindicated> [atazanavir] > contraindicated: combo may incr. sunitinib> levels, risk of toxicity (hepatic metab. inhibited) > > > Avoid/Use Alternative> [amprenavir] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [aprepitant] > use alternative: combo may incr. or decr.> sunitinib levels (hepatic metab. altered) > > [barbiturates] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [bexarotene] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [bosentan] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [carbamazepine] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [clarithromycin] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [conivaptan] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [darunavir] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [delavirdine] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. === message truncated ===Spiritual freedom is my birthright. I am a free thinker. I am able to rise above mentalprejudices and stereotypes of others. I am a free thinker. Nobody and nothing can manipulateme or deceive me. I am a free thinker. I freely choose truth and love. Today, I embrace a greater degree of spiritualfreedom.__________________________________________________

October 21, 2007

Art, until you get your body back working, I would not go off my water pills. There are other things you can take, but first get your water retention fixed. Have you found a new doctor? If you have, have you been to see him? You do need to be under a doctor's care! Water retention can raise the blood pressure, and you already have high blood pressure.

----- Original Message -----

From: Art3

Sent: Sunday, October 21, 2007 4:34 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

I'm drinking alot of water but it's starting to taste nasty and I retain alot of water and need 2 water pills but I stopped taking it and gained 5 pounds in 2 days.

Lat night I got sick of the tap water and drank cheery juice with aspertame in it and my throat started burning and now my leg hurts and cant walk again.

----- Original Message -----

From: Joyce Hudson

Sent: Sunday, October 21, 2007 12:21 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

How much water are you drinking, Art? Is your body retaining water or are you urinating good? Joy

----- Original Message -----

From: Art3

Sent: Sunday, October 21, 2007 2:27 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

I stopped taking everything and my whole legs hurts now instead of my ankle and it's hard to walk. How long will it take to get the poison out of my system?

----- Original Message -----

From: Marty Cline

Sent: Sunday, October 21, 2007 10:48 AM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

ART,I do not know where to start.YOU are being poisonedall these new pills have so many [[[ side affects]]]I would for sure try to slip them into the doctorsCoffey when he isn't looking!!STOMPINGELK--- Art3 <artfroggernet> wrote:> I take it 3 weeks off 1 week and mine is 50MG.> I have abdominal pain> anorexia> nausea/vomiting> skin discoloration> taste changes> constipation> Rash> back pain> > a.. swelling of your ankles or feet; > a.. weakness, tired feeling, nausea, loss of> appetite, weight loss; > a.. sudden numbness or weakness, especially on one> side of the body;> a.. > a.. redness, tenderness, sunburn-like peeling of the> palms of your hands or the soles of your feet; > a.. bloody, or black, tarry stools; > a.. white patches or sores inside your mouth or on> your lips. > a.. unusual or unpleasant taste in the mouth; > a.. nausea,stomach pain or upset; > a.. constipation; > a.. skin rash, hair loss, changes in skin or hair> color; or > a.. headache, joint or muscle pain. > > > > > ----- Original Message ----- > From:> .> > > for art> ----- Original Message ----- > From: Nancie Barnett > deifspiritmsn > Sent: Wednesday, October 17, 2007 6:48 PM> Subject: Clinical Information from Epocrates> Online (Premium Version)> > > > The clinical content below is part of the> Epocrates® Online database.> For a free subscription to Epocrates> Online, visit us at> http://www.epocrates.com/products/online/index.html.> > > > > Message From Sender> for art > > > > > > > > > Drug> > > > Sutent> sunitinib > > > > > Adult Dosing> > > > chemotherapy> [uses, dosing may vary]> Info: for all uses, refer to> institution protocols and pkg insert prior to> prescribing> > gastrointestinal stromal tumor,> refractory> [50 mg PO qd x4wk]> Info: repeat cycle of 4wk on and 2wk> off therapy; adjust dose in 12.5 mg increments based> on tolerability and safety; see Drug Interactions> for adjustments based on concomitant tx w/ CYP3A4> inducers or potent inhibitors> > renal cell CA, advanced> [50 mg PO qd x4wk]> Info: repeat cycle of 4wk on and 2wk> off therapy; adjust dose in 12.5 mg increments based> on tolerability and safety; see Drug Interactions> for adjustments based on concomitant tx w/ CYP3A4> inducers or potent inhibitors> > renal dosing> [not defined]> > hepatic dosing> [not defined]> > > > Peds Dosing> > > > This information is currently unavailable> or not applicable for this drug.> > > Contraindications/Cautions> > > > hypersens. to drug/class/compon.> see Drug Interactions> pregnancy not recommended> breastfeeding not recommended> CHF> caution if thromboembolic event w/in 1y> caution if ischemic cardiac event w/in 1y> caution if HTN> caution if recent surgery/trauma> caution if infection> > Drug Interactions> > > > > Contraindicated> [atazanavir] > contraindicated: combo may incr. sunitinib> levels, risk of toxicity (hepatic metab. inhibited) > > > Avoid/Use Alternative> [amprenavir] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [aprepitant] > use alternative: combo may incr. or decr.> sunitinib levels (hepatic metab. altered) > > [barbiturates] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [bexarotene] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [bosentan] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [carbamazepine] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [clarithromycin] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [conivaptan] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [darunavir] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [delavirdine] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. === message truncated ===Spiritual freedom is my birthright. I am a free thinker. I am able to rise above mentalprejudices and stereotypes of others. I am a free thinker. Nobody and nothing can manipulateme or deceive me. I am a free thinker. I freely choose truth and love. Today, I embrace a greater degree of spiritualfreedom.__________________________________________________

October 22, 2007

Art,

After reading all the messages of the last week, my conclusion is , pls get optimistic and all things will flow easier. Look to the nature and how animals are living. It will open your eyes. Start by looking to the little happy things and that can make changes in your life. Look to nice colours, absorb them mentally!!!

Selfcomplaining brings down !!! We are here all trying to help you, trying to open your eyes. So time to make changes happening with good mood that must be possible.

I attached a nice photo, use it as screenpaper !!!! Attached even two more!

Have a nice day !

e :-)

From: art@...Date: Sun, 21 Oct 2007 13:34:10 -0700Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

I'm drinking alot of water but it's starting to taste nasty and I retain alot of water and need 2 water pills but I stopped taking it and gained 5 pounds in 2 days.

Lat night I got sick of the tap water and drank cheery juice with aspertame in it and my throat started burning and now my leg hurts and cant walk again.

----- Original Message -----

From: Joyce Hudson

Sent: Sunday, October 21, 2007 12:21 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

How much water are you drinking, Art? Is your body retaining water or are you urinating good? Joy

----- Original Message -----

From: Art3

Sent: Sunday, October 21, 2007 2:27 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

I stopped taking everything and my whole legs hurts now instead of my ankle and it's hard to walk. How long will it take to get the poison out of my system?

----- Original Message -----

From: Marty Cline

Sent: Sunday, October 21, 2007 10:48 AM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

ART,I do not know where to start.YOU are being poisonedall these new pills have so many [[[ side affects]]]I would for sure try to slip them into the doctorsCoffey when he isn't looking!!STOMPINGELK--- Art3 <artfroggernet> wrote:> I take it 3 weeks off 1 week and mine is 50MG.> I have abdominal pain> anorexia> nausea/vomiting> skin discoloration> taste changes> constipation> Rash> back pain> > a.. swelling of your ankles or feet; > a.. weakness, tired feeling, nausea, loss of> appetite, weight loss; > a.. sudden numbness or weakness, especially on one> side of the body;> a.. > a.. redness, tenderness, sunburn-like peeling of the> palms of your hands or the soles of your feet; > a.. bloody, or black, tarry stools; > a.. white patches or sores inside your mouth or on> your lips. > a.. unusual or unpleasant taste in the mouth; > a.. nausea,stomach pain or upset; > a.. constipation; > a.. skin rash, hair loss, changes in skin or hair> color; or > a.. headache, joint or muscle pain. > > > > > ----- Original Message ----- > From:> .> > > for art> ----- Original Message ----- > From: Nancie Barnett > deifspiritmsn > Sent: Wednesday, October 17, 2007 6:48 PM> Subject: Clinical Information from Epocrates> Online (Premium Version)> > > > The clinical content below is part of the> Epocrates® Online database.> For a free subscription to Epocrates> Online, visit us at> http://www.epocrates.com/products/online/index.html.> > > > > Message From Sender> for art > > > > > > > > > Drug> > > > Sutent> sunitinib > > > > > Adult Dosing> > > > chemotherapy> [uses, dosing may vary]> Info: for all uses, refer to> institution protocols and pkg insert prior to> prescribing> > gastrointestinal stromal tumor,> refractory> [50 mg PO qd x4wk]> Info: repeat cycle of 4wk on and 2wk> off therapy; adjust dose in 12.5 mg increments based> on tolerability and safety; see Drug Interactions> for adjustments based on concomitant tx w/ CYP3A4> inducers or potent inhibitors> > renal cell CA, advanced> [50 mg PO qd x4wk]> Info: repeat cycle of 4wk on and 2wk> off therapy; adjust dose in 12.5 mg increments based> on tolerability and safety; see Drug Interactions> for adjustments based on concomitant tx w/ CYP3A4> inducers or potent inhibitors> > renal dosing> [not defined]> > hepatic dosing> [not defined]> > > > Peds Dosing> > > > This information is currently unavailable> or not applicable for this drug.> > > Contraindications/Cautions> > > > hypersens. to drug/class/compon.> see Drug Interactions> pregnancy not recommended> breastfeeding not recommended> CHF> caution if thromboembolic event w/in 1y> caution if ischemic cardiac event w/in 1y> caution if HTN> caution if recent surgery/trauma> caution if infection> > Drug Interactions> > > > > Contraindicated> [atazanavir] > contraindicated: combo may incr. sunitinib> levels, risk of toxicity (hepatic metab. inhibited) > > > Avoid/Use Alternative> [amprenavir] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [aprepitant] > use alternative: combo may incr. or decr.> sunitinib levels (hepatic metab. altered) > > [barbiturates] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [bexarotene] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [bosentan] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [carbamazepine] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [clarithromycin] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [conivaptan] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [darunavir] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [delavirdine] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. === message truncated ===Spiritual freedom is my birthright. I am a free thinker. I am able to rise above mentalprejudices and stereotypes of others. I am a free thinker. Nobody and nothing can manipulateme or deceive me. I am a free thinker. I freely choose truth and love. Today, I embrace a greater degree of spiritualfreedom.__________________________________________________

October 22, 2007

e, I really like that first picture. Thank you for sharing. You have given me an idea. Blessings, Joy

----- Original Message -----

From: e Bonte

natural_remedies

Sent: Monday, October 22, 2007 2:20 AM

Subject: RE: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

Art, After reading all the messages of the last week, my conclusion is , pls get optimistic and all things will flow easier. Look to the nature and how animals are living. It will open your eyes. Start by looking to the little happy things and that can make changes in your life. Look to nice colours, absorb them mentally!!! Selfcomplaining brings down !!! We are here all trying to help you, trying to open your eyes. So time to make changes happening with good mood that must be possible.I attached a nice photo, use it as screenpaper !!!! Attached even two more! Have a nice day ! e :-)

From: art@...Date: Sun, 21 Oct 2007 13:34:10 -0700Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

I'm drinking alot of water but it's starting to taste nasty and I retain alot of water and need 2 water pills but I stopped taking it and gained 5 pounds in 2 days.Lat night I got sick of the tap water and drank cheery juice with aspertame in it and my throat started burning and now my leg hurts and cant walk again.

----- Original Message -----

From: Joyce Hudson

Sent: Sunday, October 21, 2007 12:21 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

How much water are you drinking, Art? Is your body retaining water or are you urinating good? Joy

----- Original Message -----

From: Art3

Sent: Sunday, October 21, 2007 2:27 PM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

I stopped taking everything and my whole legs hurts now instead of my ankle and it's hard to walk. How long will it take to get the poison out of my system?

----- Original Message -----

From: Marty Cline

Sent: Sunday, October 21, 2007 10:48 AM

Subject: Re: [ ] Fw: Clinical Information from Epocrates Online (Premium Version)

ART,I do not know where to start.YOU are being poisonedall these new pills have so many [[[ side affects]]]I would for sure try to slip them into the doctorsCoffey when he isn't looking!!STOMPINGELK--- Art3 <artfroggernet> wrote:> I take it 3 weeks off 1 week and mine is 50MG.> I have abdominal pain> anorexia> nausea/vomiting> skin discoloration> taste changes> constipation> Rash> back pain> > a.. swelling of your ankles or feet; > a.. weakness, tired feeling, nausea, loss of> appetite, weight loss; > a.. sudden numbness or weakness, especially on one> side of the body;> a.. > a.. redness, tenderness, sunburn-like peeling of the> palms of your hands or the soles of your feet; > a.. bloody, or black, tarry stools; > a.. white patches or sores inside your mouth or on> your lips. > a.. unusual or unpleasant taste in the mouth; > a.. nausea,stomach pain or upset; > a.. constipation; > a.. skin rash, hair loss, changes in skin or hair> color; or > a.. headache, joint or muscle pain. > > > > > ----- Original Message ----- > From:> .> > > for art> ----- Original Message ----- > From: Nancie Barnett > deifspiritmsn > Sent: Wednesday, October 17, 2007 6:48 PM> Subject: Clinical Information from Epocrates> Online (Premium Version)> > > > The clinical content below is part of the> Epocrates® Online database.> For a free subscription to Epocrates> Online, visit us at> http://www.epocrates.com/products/online/index.html.> > > > > Message From Sender> for art > > > > > > > > > Drug> > > > Sutent> sunitinib > > > > > Adult Dosing> > > > chemotherapy> [uses, dosing may vary]> Info: for all uses, refer to> institution protocols and pkg insert prior to> prescribing> > gastrointestinal stromal tumor,> refractory> [50 mg PO qd x4wk]> Info: repeat cycle of 4wk on and 2wk> off therapy; adjust dose in 12.5 mg increments based> on tolerability and safety; see Drug Interactions> for adjustments based on concomitant tx w/ CYP3A4> inducers or potent inhibitors> > renal cell CA, advanced> [50 mg PO qd x4wk]> Info: repeat cycle of 4wk on and 2wk> off therapy; adjust dose in 12.5 mg increments based> on tolerability and safety; see Drug Interactions> for adjustments based on concomitant tx w/ CYP3A4> inducers or potent inhibitors> > renal dosing> [not defined]> > hepatic dosing> [not defined]> > > > Peds Dosing> > > > This information is currently unavailable> or not applicable for this drug.> > > Contraindications/Cautions> > > > hypersens. to drug/class/compon.> see Drug Interactions> pregnancy not recommended> breastfeeding not recommended> CHF> caution if thromboembolic event w/in 1y> caution if ischemic cardiac event w/in 1y> caution if HTN> caution if recent surgery/trauma> caution if infection> > Drug Interactions> > > > > Contraindicated> [atazanavir] > contraindicated: combo may incr. sunitinib> levels, risk of toxicity (hepatic metab. inhibited) > > > Avoid/Use Alternative> [amprenavir] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [aprepitant] > use alternative: combo may incr. or decr.> sunitinib levels (hepatic metab. altered) > > [barbiturates] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [bexarotene] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [bosentan] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [carbamazepine] > use alternative or consider incr.> sunitinib dose to max 87.5 mg/day and monitor> toxicity: combo may decr. sunitinib levels, efficacy> (hepatic metab. induced) > > [clarithromycin] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [conivaptan] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [darunavir] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. inhibited) > > [delavirdine] > use alternative or consider decr.> sunitinib dose to minimum 37.5 mg/day: combo may> incr. sunitinib levels, risk of toxicity (hepatic> metab. === message truncated ===Spiritual freedom is my birthright. I am a free thinker. I am able to rise above mentalprejudices and stereotypes of others. I am a free thinker. Nobody and nothing can manipulateme or deceive me. I am a free thinker. I freely choose truth and love. Today, I embrace a greater degree of spiritualfreedom.__________________________________________________

October 22, 2007

Try drinking your water with lemon in it. This will help your body

release the toxins. Also stretch, stretch, stretch!!! Lots of toxins

from medications not only accumulate in the liver and lymphs but also

in your muscles! Stretching will help squeeze out those toxins.

Imagine your muscles like a sponge, the more you stretch, the more

you ring out that sponge. Fill up on the lemon water to keep on

flushing out your system. When you get sick of lemon water switch off

to lime for a day or two.

As for the water retention grab some sea salt from the kosher end of

your supermarket and pour 1/4 of a cup into a bucket of water as hot

as you can stand it. Set it down in front of the sofa, grab your

water and let your footies soak for a half hour or so. As a nice

little bonus this too is a detox for your body.

Peppermint tea (great cold too!) will help your appetite and your

nausea. P.S. this too will count as an intake of water for flushing

your system!

Table salt with iodine in it is THE best way to disinfect your mouth.

Make a gargle with some warm water and do this morning, noon and

night. (After meals when you can eat again.) When the sores have

cleared sprinkle a bit on your toothbrush and use it as a toothpaste

from there on out.

For your pain I'd say give Arnica a try. It's a gel that is not only

a pain reliever, but a muscle repair agent. Perfect For strengthening

those muscles up after releasing all those toxins.

Drink lots of broth's with onion and garlic, and garlic, and more

garlic! Both antibiotics in a natural form that boost your immune

system to aid your body in the processing/releasing of toxins.

Some red clover tea too would aid your blood system tremendously at

this time. Wishing you many miraculous blessings and lots of love, Kat

October 22, 2007

Fantastic! Thanks for sharing! Blessings, Joy

----- Original Message -----

From: esoterickat

Sent: Monday, October 22, 2007 2:49 PM

Subject: [ ] Re: Fw: Clinical Information from Epocrates Online (Premium Version)

Try drinking your water with lemon in it. This will help your body release the toxins. Also stretch, stretch, stretch!!! Lots of toxins from medications not only accumulate in the liver and lymphs but also in your muscles! Stretching will help squeeze out those toxins. Imagine your muscles like a sponge, the more you stretch, the more you ring out that sponge. Fill up on the lemon water to keep on flushing out your system. When you get sick of lemon water switch off to lime for a day or two. As for the water retention grab some sea salt from the kosher end of your supermarket and pour 1/4 of a cup into a bucket of water as hot as you can stand it. Set it down in front of the sofa, grab your water and let your footies soak for a half hour or so. As a nice little bonus this too is a detox for your body. Peppermint tea (great cold too!) will help your appetite and your nausea. P.S. this too will count as an intake of water for flushing your system!Table salt with iodine in it is THE best way to disinfect your mouth. Make a gargle with some warm water and do this morning, noon and night. (After meals when you can eat again.) When the sores have cleared sprinkle a bit on your toothbrush and use it as a toothpaste from there on out. For your pain I'd say give Arnica a try. It's a gel that is not only a pain reliever, but a muscle repair agent. Perfect For strengthening those muscles up after releasing all those toxins. Drink lots of broth's with onion and garlic, and garlic, and more garlic! Both antibiotics in a natural form that boost your immune system to aid your body in the processing/releasing of toxins. Some red clover tea too would aid your blood system tremendously at this time. Wishing you many miraculous blessings and lots of love, Kat

December 4, 2007

Epocrates, the leading provider of handheld and web-based clinical reference

toolsto sherry:

hope this helps

nancie

The clinical content below is part of the Epocrates® Online database.

For a free subscription to Epocrates Online, visit us at

http://www.epocrates.com/products/online/index.html<http://www.epocrates.com/pro\

ducts/online/index.html>.

Drug

Tylenol

acetaminophen

Drug Interactions

Contraindicated

[acetaminophen/tramadol]

contraindicated: combo may incr. risk of acetaminophen toxicity (additive

effects, duplicate tx)

[benzocaine/butamben/tetracaine topical]

caution advised, contraindicated if <1 yo: combo may incr. risk of

methemoglobinemia (additive effects)

[lidocaine/prilocaine topical]

caution advised, contraindicated if <1 yo: combo may incr. risk of

methemoglobinemia (additive effects)

Avoid/Use Alternative

[aspirin/caffeine/CNS depressant combos]

caution advised, avoid prolonged concurrent use of aspirin and

acetaminophen: combo may incr. risk of analgesic nephropathy (additive effects)

[aspirin/dipyridamole]

caution advised, avoid prolonged concurrent use of aspirin and

acetaminophen: combo may incr. risk of analgesic nephropathy (additive effects)

[aspirin/opiate combos]

caution advised, avoid prolonged concurrent use of aspirin and

acetaminophen: combo may incr. risk of analgesic nephropathy (additive effects)

[barbiturates]

use alternative or limit acetaminophen <2 g/day: combo may incr. risk of

acetaminophen toxicity, decr. efficacy (hepatic metab. induced; incr. toxic

metabolite formation)

[carbamazepine]

use alternative or limit acetaminophen <2 g/day: combo may incr. risk of

acetaminophen toxicity, decr. efficacy (hepatic metab. induced; incr. toxic

metabolite formation)

[ethanol]

caution advised; avoid combo in chronic alcoholics: combo may incr. risk

of hepatotoxicity (additive effects; hepatic metab. induced w/ incr. formation

of toxic acetaminophen metabolites)

[rifampins]

use alternative or limit acetaminophen <2 g/day: combo may incr. risk of

acetaminophen toxicity, decr. efficacy (hepatic metab. induced; incr. toxic

metabolite formation)

Monitor/Modify Tx

[acetaminophen/butalbital]

caution advised, limit acetaminophen <4 g/day: combo may incr. risk of

acetaminophen toxicity (additive effects, duplicate acetaminophen tx)

[acetaminophen/caffeine/CNS depressant combos]

caution advised, limit acetaminophen <4 g/day: combo may incr. risk of

acetaminophen toxicity (additive effects, duplicate acetaminophen tx)

[exenatide]

give acetaminophen 1h before exenatide: combo may delay analgesic onset,

decr. peak acetaminophen levels and efficacy (absorption delayed/reduced)

[hydrocodone/ibuprofen]

monitor renal fxn: combo of NSAIDs and acetaminophen may incr. risk of

nephrotoxicity (mechanism unknown)

[ibuprofen/oxycodone]

monitor renal fxn: combo of NSAIDs and acetaminophen may incr. risk of

nephrotoxicity (mechanism unknown)

[lansoprazole/naproxen]

monitor renal fxn: combo of NSAIDs and acetaminophen may incr. risk of

nephrotoxicity (mechanism unknown)

[NSAIDs]

monitor renal fxn: combo may incr. risk of nephrotoxicity (mechanism

unknown)

[phenytoins]

caution advised, limit acetaminophen <2 g/day: combo may incr. risk of

acetaminophen toxicity, decr. efficacy (hepatic metab. induced; incr. toxic

metabolite formation)

[pramlintide]

give 1h before or 2h after pramlintide: combo may delay analgesic onset,

decr. peak acetaminophen levels and efficacy (absorption delayed/decreased)

[rifabutin]

caution advised, limit acetaminophen <2 g/day: combo may incr. risk of

acetaminophen toxicity, decr. efficacy (hepatic metab. induced, increased toxic

metabolite formation)

[warfarin]

caution advised, limit acetaminophen <2 g/day: combo may incr. INR, risk

of bleeding (hepatic metab. inhibited)

Caution Advised

[aspirin/caffeine/orphenadrine]

caution advised, avoid prolonged concurrent use of aspirin and

acetaminophen: combo may incr. risk of analgesic nephropathy (additive effects)

[benzocaine topical]

caution advised: combo may incr. risk of methemoglobinemia (additive

effects)

[black cohosh]

caution advised, especially w/ long-term or high-dose acetaminophen use:

combo may incr. risk of hepatotoxicity (additive toxicity)

[glutathione]

caution advised: combo w/ acetaminophen may decr. glutathione efficacy

(glutathione depleted by acetaminophen)

[granisetron]

caution advised: combo may decr. acetaminophen analgesic efficacy

(mechanism unknown, possible 5-HT3 antagonism)

[isoniazid]

caution advised: combo may incr. risk of hepatotoxicity (additive effects,

hepatic metab. induced; incr. toxic metabolite formation)

[kava]

caution advised, especially w/ long-term or high-dose acetaminophen use:

combo may incr. risk of hepatotoxicity (additive toxicity)

[milk thistle]

caution advised: combo may decr. acetaminophen efficacy (glucuronidation

may be enhanced by milk thistle constituent silymarin)

[nitroprusside]

caution advised: combo w/ acetaminophen may incr. risk of

methemoglobinemia (additive effects)

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December 9, 2007

Epocrates, the leading provider of handheld and web-based clinical reference

toolshi beth-

here is info from my pharmacy program that I use with my patients.

hope it helps.

nancie

Clinical Information from Epocrates Online (Premium Version)

The clinical content below is part of the Epocrates® Online database.

For a free subscription to Epocrates Online, visit us at

http://www.epocrates.com/products/online/index.html<http://www.epocrates.com/pro\

ducts/online/index.html>.

Drug

Armour Thyroid

thyroid desiccated

Drug Interactions

Contraindicated

[lemon balm]

contraindicated: combo may interfere w/ thyroid replacement therapy (lemon

balm constituents may bind thyrotropin, block thyrotropin receptor sites)

Avoid/Use Alternative

[bile acid binding resins]

use alternative or separate admin. by at least 4 to 6h: combo may decr.

thyroid hormone efficacy (absorption decreased)

Monitor/Modify Tx

[amiodarone]

monitor thyroid function, adjust thyroid replacement dose if needed:

amiodarone may alter thyroid hormone levels (complex effects on thyroid hormone

synthesis/metabolism)

[antacids]

give thyroid hormone 1h before or 4h after: combo may decr. thyroid

hormone efficacy (absorption decreased)

[barbiturates]

monitor thyroid function, adjust thyroid replacement dose if needed: combo

may decr. thyroid hormone efficacy (hepatic metab. induced)

[calcium salts]

give thyroid hormone 1h before or 4h after: combo may decr. thyroid

hormone efficacy (absorption decreased)

[carbamazepine]

monitor thyroid function, adjust thyroid replacement dose if needed: combo

may decr. thyroid hormone efficacy (hepatic metab. induced)

[diazoxide]

monitor glucose: combo may incr. risk of hyperglycemia (additive effects)

[didanosine]

give thyroid hormone 1h before or 4h after buffered didanosine: combo may

decr. thyroid hormone efficacy (absorption decreased)

[digoxin]

monitor digoxin levels when starting thyroid hormone replacement: combo

may decr. digoxin levels, efficacy (mechanism unknown, digoxin clearance

possibly increased)

[hypoglycemics, other]

monitor glucose: combo may decr. hypoglycemic agent efficacy; high dose

thyroid hormone may cause hyperglycemia (antagonistic effects)

[insulins]

monitor glucose: combo may incr. insulin requirement, high dose thyroid

hormone may cause hyperglycemia (antagonistic effects)

[iron salts, oral]

give thyroid hormone 1h before or 4h after: combo may decr. thyroid

hormone efficacy (absorption decreased)

[magnesium salts]

give thyroid hormone 1h before or 4h after: combo may decr. thyroid

hormone efficacy (absorption decreased)

[metformin/sulfonylurea combos]

monitor glucose: combo may decr. hypoglycemic agent efficacy; high dose

thyroid hormone may cause hyperglycemia (antagonistic effects)

[multivitamins with minerals]

give thyroid hormone 1h before or 4h after MVI containing iron or calcium:

combo may decr. thyroid hormone efficacy (absorption decreased)

[phenytoins]

monitor thyroid function, adjust thyroid replacement dose if needed: combo

may decr. thyroid hormone efficacy (hepatic metab. induced, clearance increased)

[raloxifene]

separate admin by 12h: combo may result in hypothyroidism, elevated TSH,

need for additional thyroid replacement drug (absorption decreased)

[rifabutin]

monitor thyroid function, adjust thyroid replacement dose if needed: combo

may decr. thyroid hormone efficacy (hepatic metab. induced)

[rifampins]

monitor thyroid function, adjust thyroid replacement dose if needed: combo

may decr. thyroid hormone efficacy (hepatic metab. induced)

[sitagliptin]

monitor glucose: combo may decr. hypoglycemic agent efficacy; high dose

thyroid hormone may cause hyperglycemia (antagonistic effects)

[sucralfate]

give thyroid hormone 1h before or 4h after: combo may decr. thyroid

hormone efficacy (absorption decreased)

[sulfonylureas]

monitor glucose: combo may decr. hypoglycemic agent efficacy; high dose

thyroid hormone may cause hyperglycemia (antagonistic effects)

[theophyllines]

monitor theophylline levels when starting thyroid hormone replacement:

combo may incr. theophylline levels, risk of toxicity (theophylline clearance

decreased)

[thiazolidinediones]

monitor glucose: combo may decr. hypoglycemic agent efficacy; high dose

thyroid hormone may cause hyperglycemia (antagonistic effects)

[warfarin]

monitor INR: changes in thyroid status may alter warfarin sensitivity

(clotting factor metab. altered)

Caution Advised

[red yeast]

caution advised, red yeast contains lovastatin: combo w/ levothyroxine may

incr. risk of thyroid function abnormalities (mechanism unknown)

[sympathomimetics, all]

caution advised: combo may incr. risk of cardiac adverse effects (additive

adrenergic effects)